CEUS- versus US- and CT-guided Biopsy for Subpleural Lung Lesions: A Prospective, Multicenter Randomized Controlled Trial
In brief
Contrast-enhanced ultrasound biopsy produced actionable diagnoses in 89% of cases
In a 2,485-person randomized trial of subpleural lung lesions, contrast-enhanced ultrasound biopsy had an 88.8% actionable diagnostic yield, versus 78.9% with CT and 76.0% with standard ultrasound. Complications occurred in 4.6%, compared with 15.8% after CT and 7.5% after standard ultrasound; the results support its use, but how well they generalize beyond the trial setting remains unknown.
- Journal
- Chest (Q1)
- Published
- 3 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ke Bi, Meng-Jun Shen, Dong Xu, Qing Tang, Yi-Xue Sun, Xiao-Fei Ye, et al.
- PMID
- 42829169
- DOI
- 10.1016/j.chest.2026.09.089
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 18 October 2026): CEUS improves diagnostic yield and safety for subpleural lesions
Abstract
BACKGROUND: Ultrasound (US)-guided percutaneous lung needle biopsy (PLNB), the guideline-recommended approach for subpleural lung lesion (SLL) diagnosis, requires comparison with CT-guided biopsy based on high-level evidence clinical studies. RESEARCH QUESTION: Is US-guided PLNB superior to CT-guided biopsy in diagnostic performance and safety, and does CEUS provide further advantages? STUDY DESIGN AND METHODS: Participants undergoing PLNB for SLLs between June 2020 and November 2023 were randomized to US-, CEUS- and CT-guided biopsies. The dual primary outcomes were diagnostic yield and disease-specific diagnostic sensitivity. Diagnostic yield was defined according to the strict ATS/ACCP definition as the proportion of biopsies yielding clinically actionable diagnoses, while sensitivity referred to the proportion of patients with a confirmed disease correctly identified by biopsy. Four secondary outcomes included complication rate, CNB/FNA utilization, puncture number, and puncture time, with the overall complication rate adopted as the key safety indicator. RESULTS: A total of 2485 participants were randomized into the US (n=828), CEUS (n=829) and CT (n=828) groups. The CEUS-guided biopsy achieved the highest diagnostic yield (CEUS: 88.8%[736/829] vs. CT: 78.9%[653/828] vs. US: 76.0%[629/828], χ2=49.046, P <0.001) , as well as the highest diagnostic sensitivity (CEUS: 86.1%[714/829] vs. CT: 74.3%[615/828] vs. US: 68.7%[569/828], χ2=72.623, P <0.001). For disease-specific analysis, CEUS yielded superior diagnostic sensitivity for malignant subtypes (CEUS: 91.8%[563/613] vs. CT: 83.2%[520/625] vs. US: 75.2%[479/637], χ2=62.259, P <0.001) and specific benign disorders (CEUS: 69.9%[151/216] vs. CT: 46.8%[95/203] vs. US: 47.1%[90/191], χ2=29.712, P <0.001). Furthermore, the CEUS group exhibited the lowest overall complication rate (CEUS: 4.6%[38/828] vs. US: 7.5%[60/802] vs. CT: 15.8%[127/805], χ2=65.322, P <0.001). INTERPRETATION: For SLL biopsy, CEUS-guided PLNB outperforms US- and CT-guided approaches in both diagnostic performance and procedural safety. CEUS guidance notably improves disease-specific diagnostic sensitivity for malignant subtypes and specific benign pulmonary disorders, serving as an optimal technique for clinical percutaneous lung biopsy. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry; No.: ChiCTR2100045374; URL: www.chictr.org.cn.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.