Echopulmonography versus computed tomographic chest predictors for differentiation between benign and malignant peripheral pulmonary and pleural lesions

BackgroundDiagnostic value of echopulmonography (EPG) in chest diseases is expanding as a guide to discriminate between benign and malignant parenchymal lesions as regards tissue characterization plus pleural lesions’ diagnostic specification.ObjectivesTo determine echopulmonography predictors of malignancy in patients with peripheral pulmonary and solid pleural lesions.Patients and methodsA prospective clinical study was conducted on 122 patients who presented with peripheral pulmonary and pleural lesions by chest X-ray. They underwent echopulmonography and CT chest evaluation. Patients were divided into two groups: Group (1), 63 patients diagnosed by CT chest and CT guided biopsy followed by EPG. Group (2), 59 patients diagnosed by EPG and ultrasound (US) guided biopsy followed by CT chest. Tissue biopsy was taken either through CT guided biopsy or ultrasound guided biopsy for pathological examination.ResultsEPG had a success rate of 75.9% in diagnosing malignancy and 17.2% in diagnosing nonmalignant lesions. Success rate of EPG based diagnosis in all studied cases was 45%. Using EPG criteria; rounded and oval morphology was statistically significantly higher in malignant than nonmalignant subgroups (53.4% versus 32.8%) in contrast to irregular morphology with ramifications that prevailed in the nonmalignant subgroup (67.2% versus 46.5%). Irregular pleural contour and heterogeneous hypoechogenicity were predominant in the nonmalignant subgroup (67.1% and 28.1%, respectively). Echoinvasion, destruction of normal tissue architecture and blood vessels displacement were more common in malignant than nonmalignant subgroups.ConclusionEchopulmonography has a worthy role in differentiating benign from malignant peripheral pulmonary and pleural lesions. US guided biopsy is performed with a low risk of complications.