Ultrasound-guided trucut biopsy of lymph node  – is it interventional pulmonologist forte?

A. Alaga*^a (Dr), G. Balakrishnan^a (Dr), C. Huan Keat^b (Mr)

^a Pulmonology Department, Hospital Sultanah Bahiyah, Alor Setar, MALAYSIA ; ^b CRC Department, Hospital Sultanah Bahiyah, Alor Setar, MALAYSIA

* arvindran_82@yahoo.com

Background: A spectrum of disease which investigated by pulmonologist can lead to cervical and axillary lymphadenopathy. Ultrasound(US) has revolutionised respiratory investigations and US-guided trucut biopsy of lymph nodes is an additional important skill for Pulmonologists. In Malaysia, cervical and axillary node biopsy usually done by Radiologists, Otorhinolaryngologist, and Surgeons. Our centre is first in Malaysia, where the US-guided trucut biopsy done by an Interventional Pulmonologist.

Objectives: We aimed to assess the feasibility of US-guided trucut biopsy of cervical and axillary lymph nodes performed by an Interventional Pulmonologist in the workup of patients with respiratory diseases.

Methods: Single-centre retrospective study. All patients that underwent US-guided lymph node sampling in our centre from 1st July 2021 to 30th April 2022 were included. The diagnosis, diagnostic yield, specimen adequacy and complication rate are reported. Their associations with the number of passes were assessed using the Fisher’s exact test.

Results: Over 9 moths, 10 patients underwent US-guided lymph node sampling by an interventional pulmonologist. 70% (7/10) of patients are male and mean age of all patients is 53.6 years. 6 of them underwent 3 passes and 4 of them underwent 4 passes of trucut biopsy with all the specimens yielded adequate results. The number of passes did not vary across characteristics, diagnosis, diagnostic yield, specimen adequacy and complications rates in the patients (p>0.05). 40% were diagnosed as metastatic adenocarcinoma of lung, 30% as metastatic squamous cell carcinoma of lung and 20% as Classical Hodkin Lymphoma and 1 of them diagnosed as small cell carcinoma of lung. There were no complications during and post procedure.

Conclusion: US-guided trucut biopsy performed by an Interventional Pulmonologists are feasible and associated with an excellent result with zero complication rate. It can reduce the number of invasive procedures performed in patients. Guidelines for training is required in future.

Disclosure of funding source(s): none