Repeated ultrasonically guided needle biopsy of small subpleural nodules.

STUDY OBJECTIVE To detect the significance of repeated ultrasonically guided needle biopsy (UGNB) for the diagnosis of nodular lesions </= 2 cm in diameter. DESIGN Retrospective study to evaluate the diagnostic yield of UGNB. SETTING University hospital, outpatients, and inpatients of the respiratory department. PATIENTS One hundred seven cases with small nodular lesions </= 2 cm in diameter in contact with the pleura. Sixty-two of 107 cases were malignant, and the others were benign diseases. RESULTS Initial UGNB identified 56% (35/62) of the malignant lesions and 16% (7/45) of the benign lesions, ie, 39% (42/107) of the total. In 35 of 65 cases that were not diagnosed by the initial UGNB, it was repeated. Diagnostic yields of the second UGNB were 68% (13/19) of the malignant cases, 25% (4/16) of the benign cases, yielding a total of 49% (17/35) in those reexamined. Furthermore, 51 of 65 patients with negative findings on the initial UGNB underwent fiberoptic bronchoscopy. The resulting diagnostic yields were 22% (5/23) from the malignant lesions and 18% (5/28) from the benign lesions, 20% (10/51) in total. Thus, among the malignant cases, the repetition of UGNB increased the definitive diagnostic yield from 56% (the initial UGNB) to 77%. In these small tumors, no serious complications were caused by the procedure. CONCLUSIONS UGNB should be performed twice for a definitive diagnosis of small subpleural nodules before deciding on surgical biopsy or follow-up.