Authors (including presenting author) :
Wong TW(1), Tsui YW(1), Chan YH(1), Hong YF(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Tuen Mun Hospital
Keyword 3: :
diagnostic yield
Keyword 4: :
ultrasound guided
Keyword 5: :
Pulmonologists
Keyword 6: :
Genetics and Genomics
Introduction :
Timely tissue diagnosis is critical for initiating personalized cancer treatment, yet access to conventional biopsy pathways is often constrained by long waits, particularly for advanced bronchoscopic and CT-guided procedures. The median waiting time is over 4 weeks for bronchoscopic biopsy and even longer for CT-guided biopsy, contributing to patient anxiety and potential clinical deterioration. We piloted a pulmonologist-performed, bedside ultrasound-guided lung biopsy service targeting ultrasound-accessible peripheral lesions as a rapid and safe alternative within a multidisciplinary diagnostic pathway.
Objectives :
1. Assess the feasibility of implementing a formal bedside lung biopsy service for non-operable lung cancer patients. 2. Characterize service demand, waiting times, diagnostic yield, and safety to inform future service planning.
Methodology :
This was a retrospective study on patients requiring transthoracic lung biopsy from May 2025 to November 2025. Inclusion criteria included inoperable staging, peripherally located lesions. Cases were reviewed in pulmonology team meetings or multidisciplinary conferences with thoracic surgery and radiology for optimal diagnostic methods. Two pulmonologists performed bedside thoracic ultrasonography; if the lesion was sonographically accessible, fine-needle aspiration (FNA) was performed using a 22G lumbar puncture needle (selected for availability, cost, and echogenicity). If imaging suggested necrosis or a benign process, an 18G trucut needle (renal-biopsy type) was employed. Patients were observed for 4 hours post-procedure with routine chest radiography to exclude pneumothorax. Final diagnoses and adequacy for oncologic decision-making (including molecular testing) were recorded and compared against the bedside biopsy results.
Result & Outcome :
Across 6 months, 43 bedside biopsies were performed in 41 patients (2 patients needed to repeat bedside biopsy). Median waiting time for biopsy was 3 days (mean 3.75 days), 95.3% (41/43) of procedures were completed within one week of referral. Final diagnoses were available in 40 patients including 1 tuberculosis. Pathological diagnosis adequate for treatment decision was established with bedside biopsy in 33 (84.6%) out of 39 cancer patients, in which 2 patients had second attempt. Three out of the remaining 6 patients had malignant cells yet inadequate tissue for genomics, and 3 with non-diagnostic results, requiring repeating biopsy with other means.
There was only one pneumothorax (2.3%), which resolved with conservative management. Compared with international reports, our diagnostic yield was comparable with a lower complication rate. Conclusion:
A pulmonologist-led, bedside, ultrasound-guided lung biopsy service is feasible, safe, and substantially shortens time to tissue diagnosis for non-operable lung cancer with ultrasound-accessible peripheral lesions. This service evaluation supports integration of this approach into a one-stop (day procedure), multidisciplinary diagnostic pathway to expedite personalized cancer care. Further expansion and longitudinal evaluation are warranted to optimize molecular adequacy rates and define resource requirements.
