Amaç: Torasik ultrasonografi (USG) rehberliğinde yapılan girişimsel işlemlerin özelliklerini incelemek. Gereç ve Yöntemler: Ocak 2021-Aralık 2022 tarihleri arasında torasik USG rehberliğinde işlem yapılan olguların dosyaları geriye dönük olarak incelendi. Olguların klinik-demografik, radyolojik bulguları kayıt edildi. Torasik USG rehberliğinde yapılan tüm tanısal işlemler, var ise işlem sonrası komplikasyonlar kayıt edildi. Bulgular: Çalışmaya yaş ortalaması 69,3±12,1 olan, 45'i (%36,3) kadın, 79'u (%63,7) erkek olmak üzere toplam 124 olgu dâhil edildi. Seksen bir (%65,3) olguya torasentez amaçlı, 33 (%26,6) olguya biyopsi amaçlı, 10 (%8,1) olguya plevral kateter takılması amacı ile torasik USG yapıldı. Torasentez işlemleri incelendiğinde; 61 (%49,1) olguya tanısal torasentez, 20 (%16,1) olguya terapötik amaçlı torasentez yapıldığı görüldü. Biyopsi işlemleri incelendiğinde, akciğerde primer kitle lezyonu olan 20 (%16,1) olguya USG rehberliğinde transtorasik ince iğne aspirasyon biyopsisi (TTİAB) yapıldığı, akciğerde primer kitle lezyonu olup göğüs duvarı metastazı olan 5 (%4) olguya göğüs duvarı lezyonuna TTİAB, yine primer akciğer malignitesi şüphesi olup supraklavikular lenfadenopatisi (LAP) tespit edilen 3 (%2,4) olguya supraklavikular LAP'a İAB yapıldığı, ayrıca plevral sıvı nedeni ile tetkik edilip plevral biyopsi endikasyonu koyulan 5 (%4) olguya da USG rehberliğinde plevral tru-cut biyopsi yapıldığı görüldü. Sonuç: Seçilmiş olgularda ve girişimsel işlemlerde torasik USG'nin tanı başarısı yüksektir ve USG rehberliğinde yapılan girişimsel işlemlerde komplikasyon oranı düşüktür.
Anahtar Kelimeler: Biyopsi; torasentez; torasik ultrasonografi
Objective: To examine the characteristics of interventional procedures performed under the guidance of thoracic ultrasonography (USG). Material and Methods: The files of the cases who underwent procedures under thoracic USG guidance between January 2021 and December 2022 were examined retrospectively. Clinical-demographic and radiological findings of the cases were recorded. All diagnostic procedures performed under the guidance of thoracic USG and post-procedural complications, if any, were recorded. Results: A total of 124 cases, 45 (36.3%) women and 79 (63.7%) men, with a mean age of 69.3±12.1 years, were included in the study. Thoracic USG was performed for thoracentesis in 81 (65.3%) cases, for biopsy in 33 (26.6%) cases, and for pleural catheter insertion in 10 (8.1%) cases. When thoracentesis procedures were examined, it was seen that diagnostic thoracentesis was performed in 61 (49.1%) cases and therapeutic thoracentesis was performed in 20 (16.1%) cases. When the biopsy procedures were examined, USG-guided transthoracic fine needle aspiration biopsy (TTNAB) was performed in 20 (16.1%) cases with a primary mass lesion in the lung, and TTNAB was performed on the chest wall lesion in 5 (4%) cases with a primary mass lesion in the lung and chest wall metastasis. Again, NAB was performed on supraclavicular LAP in 3 (2.4%) cases with supraclavicular lymphadenopathy (LAP) and suspicion of primary lung malignancy. In addition, pleural tru-cut biopsy was performed under USG guidance in 5 (4%) cases who were examined for pleural fluid and indicated for pleural biopsy. Conclusion: The diagnostic success rate of thoracic USG is high in selected cases and interventional procedures, and the complication rate is low in USG-guided interventional procedures.
Keywords: Biopsy; thoracentesis; thoracic ultrasonography
- Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, et al. New international guidelines and consensus on the use of lung ultrasound. J Ultrasound Med. 2023;42(2):309-44. [Crossref] [PubMed] [PMC]
- Bourgouin PP, Rodriguez KJ, Fintelmann FJ. Image-guided percutaneous lung needle biopsy: how we do it. Tech Vasc Interv Radiol. 2021;24(3):100770. [Crossref] [PubMed]
- Stanton AE, Edey A, Evison M, Forrest I, Hippolyte S, Kastelik J, et al. British thoracic society training standards for thoracic Ultrasound (TUS). BMJ Open Respir Res. 2020;7(1):e000552. [Crossref] [PubMed] [PMC]
- Annessi V, Paci M, De Franco S, Cavazza A, Ferrari G, Ricchetti T, et al. Diagnosis of anterior mediastinal masses with ultrasonically guided core needle biopsy. Chir Ital. 2003;55(3):379-84. [PubMed]
- Doğan C, Kıral N, Parmaksız ET, Çağlayan B, Sağmen SB, Salepçi B, et al. Ultrasonographic evaluation of lung parenchyma involvement in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2019;36(2):130-40. [PubMed] [PMC]
- Evison M, Blyth KG, Bhatnagar R, Corcoran J, Saba T, Duncan T, et al. Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians. BMJ Open Respir Res. 2018;5(1):e000307. [Crossref] [PubMed] [PMC]
- Jones PW, Moyers JP, Rogers JT, Rodriguez RM, Lee YC, Light RW. Ultrasound-guided thoracentesis: is it a safer method? Chest. 2003;123(2):418-23. [Crossref] [PubMed]
- Doran J, Hanna R, Nyagura-Mangori T, Mahotra N, Das SK, Borok M, et al. Stakeholder perspectives on current determinants of ultrasound-guided thoracentesis in resource limited settings: a qualitative study. BMJ Open. 2022;12(12):e064638. [Crossref] [PubMed] [PMC]
- Diacon AH, Theron J, Schubert P, Brundyn K, Louw M, Wright CA, et al. Ultrasound-assisted transthoracic biopsy: fine-needle aspiration or cutting-needle biopsy? Eur Respir J. 2007;29(2):357-62. [Crossref] [PubMed]
- Laursen CB, Naur TM, Bodtger U, Colella S, Naqibullah M, Minddal V, et al. Ultrasound-guided lung biopsy in the hands of respiratory physicians: diagnostic yield and complications in 215 consecutive patients in 3 centers. J Bronchology Interv Pulmonol. 2016;23(3):220-8. [Crossref] [PubMed]
- Doğan C, Cömert SŞ, Salepçi B, Kıral N, Parmaksız ET, Çağlayan B. Efficient and safe method in diagnosis of thoracic lesions: Ultrasound-guided needle aspiration biopsy. Eurasian Journal of Pulmonology. 2019;21(3):148-55. [Crossref]
- Choe J, Kim MY, Baek JH, Choi CM, Kim HJ. Ultrasonography-guided core biopsy of supraclavicular lymph nodes for diagnosis of metastasis and identification of epidermal growth factor receptor (EGFR) mutation in advanced lung cancer. Medicine (Baltimore). 2015;94(29):e1209. Erratum in: Medicine (Baltimore). 2015;94(33):1. [Crossref] [PubMed] [PMC]
- Jany B, Welte T. Pleural effusion in adults-etiology, diagnosis, and treatment. Dtsch Arztebl Int. 2019;116(21):377-86. [PubMed] [PMC]
- Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77(4):507-13. [Crossref] [PubMed]
- Benamore RE, Scott K, Richards CJ, Entwisle JJ. Image-guided pleural biopsy: diagnostic yield and complications. Clin Radiol. 2006;61(8):700-5. [Crossref] [PubMed]
- Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest. 2010;137(6):1362-8. [Crossref] [PubMed]
- Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii4-17. [Crossref] [PubMed]
- Metintas M, Yildirim H, Kaya T, Ak G, Dundar E, Ozkan R, et al. CT scan-guided abrams' needle pleural biopsy versus ultrasound-assisted cutting needle pleural biopsy for diagnosis in patients with pleural effusion: a randomized, controlled trial. Respiration. 2016;91(2):156-63. [Crossref] [PubMed]
- Chang DB, Yang PC, Luh KT, Kuo SH, Yu CJ. Ultrasound-guided pleural biopsy with Tru-Cut needle. Chest. 1991;100(5):1328-33. [Crossref] [PubMed]
- Zhang Y, Tang J, Zhou X, Zhou D, Wang J, Tang Q. Ultrasound-guided pleural cutting needle biopsy: accuracy and factors influencing diagnostic yield. J Thorac Dis. 2018;10(6):3244-52. [Crossref] [PubMed] [PMC]
- TUKMOS. Tıpta Uzmanlık Kurulu Müfredat Oluşturma ve Standart Belirleme Sistemi. 2016. Erişim tarihi: 8 Haziran 2023. Erişim linki: [Link]
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