Ultrasound-guided Transthoracic Needle Biopsy in a Resource Limited Setting - A Case Report and Feasibility Analysis

• DOI: https://doi.org/10.22533/at.ed.5722410095

• Palavras-chave: Ultrasound, Transthoracic Needle Biopsy, Plueral Mass, Lung Mass, Thoracic Oncology, Thoracic Surgery

• Keywords: Oncology, Medicine, Biopsy, Computer Topography, Chest, Malignancy

• Abstract: Case Presentation: An 83-year-old female with a history of remote Left Breast Cancer post Left Modified Radical Mastectomy and External Beam Radiotherapy. Presented for evaluation of incidental lung mass on CT scan of chest in preparation for retrosternal goiter resection following presentation for evaluation of neck mass, identified as non-malignant retrosternal goiter. The patient was subsequently referred to the thoracic surgery clinic for further management. Patient had significant financial challenges, limiting significant options for biopsy of lung mass. Alongside a visiting pulmonary physician with experience in thoracic ultrasonography, the patient was offered ultrasound-guided lung biopsy at her clinic visit and same was successful. Equipment required were relatively easy to acquire and patient’s cost for equipment was limited primarily to 24-gauge tru-cut biopsy needle. Biopsy results revealed, Invasive Squamous Cell Carcinoma – moderately differentiated.  The patient was subsequently referred to the Oncologist for further care. Discussion: Lung cancer is an increasing problem in the developing world due to a multitude of factors including persisting increasing trends in cigarette smoking, there are significant disparities in access to diagnostic options. Despite the relative prevalence of bedside ultrasonography in resource-rich settings, it’s prevalence in resource-limited settings as a key adjunct  to biopsy of lung masses remain limited. There are significant disparities in access to health care facilities and inequitable distribution of resources and treatment options for lung cancer patients. Relative improvements in mortality currently seen in resource-rich settings currently do not extend to low-to middle income settings. A multi-faceted approach is required to truly tackle this disparity, including providing alternative options for biopsy of lung masses. In Jamaica, patient’s are often limited in their options for biopsy of lung masses, depending on access to financial funding which can significantly limit their access to treatment options. Our patient represents the typical patient that has been described in resource limited settings and the availability of a relatively low-risk procedure continues to limit timely diagnosis. Conclusion:                    There is a need for increasing training and multi-faceted options to the diagnosis and management of lung cancer in resource-limited settings.