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Cancers
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Advances in Lung Ultrasound in Cancer Patients
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Advances in Lung Ultrasound in Cancer Patients

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 30 July 2026 | Viewed by 8095

Special Issue Editors

Dr. Helmut Prosch

E-Mail Website
Guest Editor
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Interests: thoracic imaging; saging; lung cancer; ultrasound; lung ultrasound; CEUS; oncologic imaging
Dr. Ehsan Safai Zadeh

E-Mail Website
Guest Editor
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
Interests: lung cancer; ultrasound; lung ultrasound; CEUS; elastography; oncologic Imaging

Special Issue Information

Dear Colleagues,

Computed tomography (CT) and positron emission tomography-CT (PET-CT) are the primary imaging modalities for diagnosing and staging neoplastic lung lesions. However, lung ultrasound (LUS) can serve as a valuable complementary method. LUS is used in clinical practice for the histologic confirmation of lung lesions and can be advantageous in the staging of lung cancer. Additionally, contrast-enhanced ultrasound (CEUS) provides valuable information in evaluating pulmonary lesions. This Special Issue aims to highlight the benefits of ultrasound as a complementary method to cross-sectional imaging in the evaluation of neoplastic lung lesions.

Dr. Helmut Prosch
Dr. Ehsan Safai Zadeh
Guest Editors

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Keywords

  • lung ultrasound
  • neoplastic pleuro-pulmonary lesions
  • lung cancer
  • oncologic imaging
  • ultrasound
  • CEUS
  • elastography

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Published Papers (6 papers)

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Research

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20 pages, 1136 KB  
Article
Endobronchial Ultrasound Staging During Navigation Bronchoscopy for Peripheral Pulmonary Nodules in the Real World: Which Patients Will Benefit?
by Desi K. M. ter Woerds, Roel L. J. Verhoeven, Ad F. T. M. Verhagen, Erik H. J. G. Aarntzen and Erik H. F. M. van der Heijden
Cancers 2025, 17(10), 1700; https://doi.org/10.3390/cancers17101700 - 19 May 2025
Cited by 1 | Viewed by 2188 | Correction
Abstract
Background/Objectives: The prevalence of lung cancer in patients with a peripheral pulmonary nodule referred for navigation bronchoscopy (NB) is high. Combining NB with a systematic EBUS for staging is common practice. We investigated the added value of performing EBUS in the population referred [...] Read more.
Background/Objectives: The prevalence of lung cancer in patients with a peripheral pulmonary nodule referred for navigation bronchoscopy (NB) is high. Combining NB with a systematic EBUS for staging is common practice. We investigated the added value of performing EBUS in the population referred for NB in relation to the available pre-procedural [18F]FDG-PET and CT imaging information. Methods: This single-center study evaluated all consecutive patients who underwent an NB in an academic referral center. [18F]FDG-PET and CT scoring of lymphadenopathy was based on routine [18F]FDG-PET and/or contrast-enhanced chest (ce) CT imaging reports and were correlated to outcome of systematic EBUS and subsequent surgery (when available). Results: In total, 403 patients were included for analysis of which 327 underwent EBUS (81.1%). In 138/403 patients (35%) who had positive lymph nodes on [18F]FDG-PET (86.5%) or ceCT (13.5%), 12 lung cancer patients were diagnosed with N+ disease by EBUS (8.4%). An additional nine EBUS-negative patients were diagnosed with N+ disease after surgery (5.4%). In the group of patients with imaging-negative lymph nodes (65.8%), no metastatic lymph nodes were found by EBUS, and surgery revealed occult nodal metastasis in eight patients (3.1%). Conclusions: In patients with peripheral pulmonary nodules referred for NB, EBUS may be safely omitted when [18F]FDG-PET or ceCT imaging does not indicate presence of nodal involvement. Full article
(This article belongs to the Special Issue Advances in Lung Ultrasound in Cancer Patients)
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11 pages, 6012 KB  
Article
Perfusion Patterns of Peripheral Pulmonary Metastasis Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Pattern
by Johannes Kroenig, Christian Görg, Helmut Prosch, Lara Von Schumann, Christina C. Westhoff, Amjad Alhyari, Felix R. M. Koenig, Hajo Findeisen and Ehsan Safai Zadeh
Cancers 2024, 16(19), 3365; https://doi.org/10.3390/cancers16193365 - 1 Oct 2024
Cited by 4 | Viewed by 1475
Abstract
Purpose: Description of the perfusion of pulmonary metastasis by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns represented by immunohistochemical CD34 endothelial staining. Patients and methods: The data of 54 patients with histologic proven peripheral pulmonary metastasis, investigated between 2004 and 2023 [...] Read more.
Purpose: Description of the perfusion of pulmonary metastasis by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns represented by immunohistochemical CD34 endothelial staining. Patients and methods: The data of 54 patients with histologic proven peripheral pulmonary metastasis, investigated between 2004 and 2023 by CEUS. These CEUS parameters were evaluated: time to enhancement (TE), categorized as early pulmonary-arterial (PA) or delayed bronchial-arterial (BA) patterns; extent of enhancement (EE), either marked or reduced; homogeneity of enhancement (HE), homogeneous or inhomogeneous; and decrease of enhancement (DE), rapid washout (<120 s) or late washout (≥120 s). Additionally, tissue samples in 45 cases (83.3%) were stained with CD34 antibody for immunohistochemical analysis. Results: In total, 4 lesions (7.4 %) exhibited PA enhancement, and 50 lesions (92.6%) demonstrated BA enhancement. Furthermore, 37 lesions (68.5%) showed marked enhancement, while 17 lesions (31.5%) exhibited reduced enhancement. The enhancement was homogeneous in 28 lesions (51.86%) and inhomogeneous in 26 lesions (48.14%). Additionally, 53 lesions (98.1%) displayed a rapid washout. A chaotic vascular pattern indicative of a bronchial arterial blood supply was identified in all cases (45/45, 100%), including all 4 lesions with PA enhancement. Conclusion: Pulmonary metastases in CEUS predominantly reveal bronchial arterial enhancement and a rapid washout. Regarding EE and HE, pulmonary metastases show heterogeneous perfusion patterns. A PA enhancement in CEUS does not exclude BA neoangiogenesis. Full article
(This article belongs to the Special Issue Advances in Lung Ultrasound in Cancer Patients)
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Review

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14 pages, 8148 KB  
Review
Lung Ultrasound for Pleural Effusion in Cancer Patients: Advanced Ultrasound for Pleural Lesions—A Narrative Review
by Hajo Findeisen, Christian Görg, Viktoria Zies, Michael Ludwig, Christoph F. Dietrich, Amjad Alhyari and Corinna Trenker-Burchert
Cancers 2026, 18(1), 38; https://doi.org/10.3390/cancers18010038 - 22 Dec 2025
Viewed by 1068
Abstract
Background: Pleural effusion (PE) is a frequent complication in patients with malignancies and is often associated with poor prognosis. Lung ultrasound (LUS) has become an indispensable bedside tool for detecting, characterizing, and guiding the management of pleural effusions. Methods: This narrative review summarizes [...] Read more.
Background: Pleural effusion (PE) is a frequent complication in patients with malignancies and is often associated with poor prognosis. Lung ultrasound (LUS) has become an indispensable bedside tool for detecting, characterizing, and guiding the management of pleural effusions. Methods: This narrative review summarizes the current evidence on the diagnostic performance of LUS for PE in cancer patients, emphasizing recent advances in functional ultrasound techniques. Results: B-mode LUS can detect small-volume effusions and estimate their volume. Sonographic features such as echogenicity, septations, and pleural abnormalities can help differentiate transudative from exudative effusions. Shear-wave elastography and contrast-enhanced ultrasound provide additional functional information on tissue stiffness and perfusion. This information may help distinguish between malignant and benign pleural lesions and facilitate targeted biopsy when cytology is nondiagnostic. Compared with computed tomography, LUS offers superior evaluation of juxtadiaphragmatic and pleural surface abnormalities. It facilitates safe, real-time thoracocentesis. Recent innovations, including improved quality, affordable handheld ultrasound systems and artificial intelligence-based analysis, are expected to further enhance diagnostic precision and accessibility. Conclusions: Although LUS is a sensitive and versatile tool for assessing PE in cancer patients, it has limited diagnostic accuracy in distinguishing between benign and malignant effusions. Advanced techniques, such as shear-wave elastography and contrast-enhanced ultrasound, may further support the differentiation of malignant and benign diseases. Ongoing technological advances are likely to enhance the diagnostic accuracy and accessibility of lung ultrasound. Full article
(This article belongs to the Special Issue Advances in Lung Ultrasound in Cancer Patients)
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13 pages, 5164 KB  
Review
Emerging Role of Transcutaneous Ultrasound in the Diagnostic of Lung Cancer
by Corinna Trenker-Burchert, Marius Dohse, Hajo Findeisen, Andreas Schuler and Christian Görg
Cancers 2025, 17(23), 3873; https://doi.org/10.3390/cancers17233873 - 2 Dec 2025
Cited by 1 | Viewed by 900
Abstract
Lung cancer is one of the most commonly diagnosed malignancies worldwide and continues to be a leading cause of cancer-related mortality. Precise staging is crucial for predicting outcomes and directing treatment decisions. Current international guidelines mainly recommend imaging techniques like CT and PET-CT, [...] Read more.
Lung cancer is one of the most commonly diagnosed malignancies worldwide and continues to be a leading cause of cancer-related mortality. Precise staging is crucial for predicting outcomes and directing treatment decisions. Current international guidelines mainly recommend imaging techniques like CT and PET-CT, with limited references to transcutaneous ultrasound, which is only suggested in particular clinical cases. Ultrasound provides real-time imaging, high resolution in near-field structures, and the ability to assess thoracic wall infiltration, supraclavicular and cervical lymph nodes, pleural effusions, and metastatic lesions. Furthermore, ultrasound-guided biopsies can enable quick and safe histological confirmation of accessible lesions. Based on these advantages and a review of current literature, we propose that integrating ultrasound into staging algorithms could improve diagnostic efficiency, decrease invasive procedures, and support prompt treatment planning. We also highlight the need for further research in this area. Full article
(This article belongs to the Special Issue Advances in Lung Ultrasound in Cancer Patients)
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Other

Jump to: Research, Review

2 pages, 156 KB  
Correction
Correction: ter Woerds et al. Endobronchial Ultrasound Staging During Navigation Bronchoscopy for Peripheral Pulmonary Nodules in the Real World: Which Patients Will Benefit? Cancers 2025, 17, 1700
by Desi K. M. ter Woerds, Roel L. J. Verhoeven, Ad F. T. M. Verhagen, Erik H. J. G. Aarntzen and Erik H. F. M. van der Heijden
Cancers 2025, 17(15), 2450; https://doi.org/10.3390/cancers17152450 - 24 Jul 2025
Viewed by 512
Abstract
Error in Table [...] Full article
(This article belongs to the Special Issue Advances in Lung Ultrasound in Cancer Patients)
13 pages, 643 KB  
Systematic Review
Role of Quantitative CEUS in the Diagnosis of Peripheral Pulmonary Lesions: A Systematic Review
by Andrea Boccatonda, Alice Brighenti, Sofia Maria Bakken, Damiano D’Ardes, Cosima Schiavone, Fabio Piscaglia and Carla Serra
Cancers 2025, 17(10), 1697; https://doi.org/10.3390/cancers17101697 - 18 May 2025
Cited by 2 | Viewed by 1179
Abstract
Background/Objectives: This systematic review describes a largely descriptive synthesis of studies investigating the diagnostic performance of quantitative contrast-enhanced ultrasound (CEUS) in differentiating benign from malignant peripheral pulmonary lesions. Methods: Formal quantitative pooling of effect sizes was not feasible due to variability in [...] Read more.
Background/Objectives: This systematic review describes a largely descriptive synthesis of studies investigating the diagnostic performance of quantitative contrast-enhanced ultrasound (CEUS) in differentiating benign from malignant peripheral pulmonary lesions. Methods: Formal quantitative pooling of effect sizes was not feasible due to variability in outcome measurements and reporting. Results: Combining CEUS parameters with real-time on-site evaluation (ROSE) substantially improved percutaneous biopsy success rates. In one comparative study, biopsy yield reached 97.62% with CEUS, versus 84% using conventional ultrasound, while complications remained minimal. Other investigations focused on the discriminatory value of specific time-based indices (e.g., AT ≥ 10 s, lesion-lung AT difference ≥ 2.5 s) or complex multi-parameter models. A notable large study demonstrated that a six-parameter logistic regression model achieved near-excellent discrimination, with C-statistics exceeding 0.97 for both development and validation cohorts, outperforming single-threshold approaches. Nevertheless, certain findings emphasize that no single indicator—particularly arrival time alone—reliably distinguishes benign from malignant lesions, given the diverse vascular patterns and histological subtypes involved. TDOA-based analyses proved more promising, as malignant lesions generally exhibit a delayed but robust bronchial arterial supply and rapid washout. Heterogeneity in ultrasound systems, operator experience, and patient populations further underscores the need for standardized protocols. Conclusions: Overall, these data suggest that CEUS, particularly when combined with additional sonographic or cytological tools, significantly enhances diagnostic precision for peripheral pulmonary lesions. Full article
(This article belongs to the Special Issue Advances in Lung Ultrasound in Cancer Patients)
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