The value of physician led US-guided biopsies in lung cancer

Abstract

<bold>Background:</bold> A respiratory physician-led ultrasound-guided biopsy service was established in a teaching hospital with large Lung Cancer Service. The aim was to reduce delays in the lung cancer diagnostic pathway and relieve the pressure on commonly accessed procedures such as EBUS. <bold>Aim:</bold> The aims of the study were to evaluate the range of procedures performed, and their diagnostic accuracy, and to assess the value of this service in lung cancer diagnostics. <bold>Method:</bold> A retrospective review of consecutive patients who underwent ultrasound-guided biopsies by respiratory physicians between 2023 and 2024 benchmarking results with those of EBUS during the same period. <bold>Results:</bold> A total of 67 biopsies were performed, with overall diagnostic accuracy of 94%. Diagnostic accuracy for pleural biopsies was 93.33% (14/15), cervical lymph node biopsies was 96.88% (31/32), lung biopsies was 87.5% (14/16), and chest wall biopsies was100% (4/4). No post-procedural complications were observed. 55/63 of diagnostic biopsies confirmed malignancy (45 lung cancers, 5 mesotheliomas, 3 lymphomas), and 8 were benign. 1 patient required re-biopsy for molecular testing. Regarding timeliness, 28.36% (19) of biopsies were performed on the same day as referral, and 53.73% (36) were completed within 48 hours. 98.51% (66) were done within 7 days, with an average time from referral to biopsy of 2.48 days and a re-biopsy rate of 7.46% (4 undiagnostic + 1 for molecular markers). In comparison, the median time to procedure for EBUS was 23 days, with a re-biopsy rate of 15%. <bold>Conclusion:</bold> Physicians-ultrasound-guided biopsy service reduces diagnostic delays allowing avoiding more invasive procedures. Diagnostic accuracy is comparable to radiologists’ series.