الفهرس 
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Abstract
SUMMARY & CONCLUSION
Ultrasonic examination of the chest is a rapidly developing application and in many centers it is considered as the first choice for either diagnostic imaging or guided interventions for chest tumors.
Transthoracic ultrasound is valuable for the evaluation of a wide variety of chest diseases, particularly when the pleural cavity is involved. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space.
The advantages of US guidance include the real-time, continuous monitoring of the needle during advancement and sampling; the availability of oblique needle paths; and the ability to perform the biopsy at the bedside of critically ill patients or to have patients with dyspnea who cannot tolerate a supine position in semi-sitting positions during the biopsy. Under real-time ultrasound guidance the success rates of invasive procedures increase significantly whereas the risks are greatly reduced.
The advantages of low cost, bedside availability and no radiation exposure have made ultrasound an indispensable diagnostic tool in modern pulmonary medicine.
Percutaneous Ultrasound guided biopsy has a minimal complications and limitations as compared to other modalities. This could include movement of the mass with breathing, pneumothorax and hemothorax.
The present study was conducted on 60 patients that had radiographic evidence of thoracic mass suspected of malignancy and was selected from chest out patient clinic in Beni-Suef University Hospital and Chest Department, Kasr El-Aini hospital in the period from December 2017 to December 2018.
Aim of the current study is to measure sensitivity, and accuracy of ultra sound guided percutaneous core needle biopsy in different thoracic tumors (lung, pleural, chest wall and mediastinal).
The patients were subjected basically to full history taking, full clinical examination, routine laboratory assessment, bleeding profile, chest X-ray and CT chest.
All patients were examined by transthoracic ultrasonography. Overall, 60 patients underwent Tru-cut biopsy assisted by TUS, No complications occurred during or after the procedures.
In the current study the total number of diagnosed cases by TUS guided biopsy was 60 patients who represent the study population.
In this study, by regarding the overall sensitivity & accuracy of transthoracic US findings in relation to CT chest findings, it was found that both modalities agreed to each other in detection of pleural effusion, pleural mass and superior vena cava obstruction. Although TUS was superior over CT chest in detection of parenchymal mass, pleural thickening and axillary, SCLN and lower deep cervical lymph node. While CT chest was superior over TUS in detection of pulmonary nodule, central mass.
Regarding chest wall invasion, it was found that sonar was superior in detection of soft tissue invasion, while CT chest was superior in detection of bone invasion.
The results of this study showed that the majority of cases had extra-pulmonary tumors, followed by pulmonary tumors and just (8.33 %) of them had inflammatory lesion.
In present study histopathological Analysis of Tru-cut biopsy revealed that (28.33%) of diagnosed patients (17 cases) are bronchogenic carcinoma, followed by Metastatic Adenocarcinoma 13 cases (21.67%), then Malignant mesothelioma 10 cases (16.67%), then Malignant lymphoma 5 cases (8.33%), 3 cases (5%) diagnosed as thymoma, 3 cases (5%) diagnosed as TB, 2cases (3.33%) diagnosed as sarcoma, 2 cases (3.33%) diagnosed as neurofibroma, 1 case (1.67%) diagnosed as organizing pneumonia, 1 case (1.67%) diagnosed as fibrosis, 1 cases (1.67%) diagnosed as Rhabdomyoma, 1 case (1.67%) diagnosed as plasma cell tumor, 1 cases (1.67%) diagnosed as Schwanoma.
Ultrasound detected vascularity of lesions through Doppler study and showed that most of lesions had moderate vascularity in both malignant and non-malignant lesions also in all anatomical thoracic sites
The current study showed that smoking was mainly linked to malignant diseases especially bronchogenic carcinoma.
The current study results showed that occupational and residence hazards are risk factors in the pathogenesis of bronchogenic carcinoma and mesothelioma.
In this study in both malignant and non-malignant lesions, most abundant lesion size was 0.5-3 cm
In this study, assessment of sonar guided true cut needle biopsy has shown that the technique sensitivity, PPV and accuracy for detection of chest tumors, were depending on the site of lesion; hence they were in chest wall, mediastinum, lung, and pleura (100 %) for all, and in LN (88.9, 100 and 90.9 %) respectively. The overall diagnostic performance of sonar guided true cut needle biopsy in diagnosis was 97.78 % sensitivity, 98.18% accuracy, and 100 % PPV.
Finally, it can be concluded that percutaneous transthoracic core biopsy with Tru-Cut needle under ultrasound guidance is a safe and sensitive way to obtain specimens for accurate histologic diagnosis of thoracic tumors. The diagnostic yield is high, and the technique, relatively simple, can also be used for outpatients.