Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer

Abstract

Background: Although the use of radial endobronchial ultrasound (R-EBUS) with a guide sheath has shown improved diagnostic capability in peripheral pulmonary lesions, its utility is still low due to variable performance. To overcome its limitation, we evaluated the feasibility and efficacy of R-EBUS combined with transbronchial biopsy (TBB) under fluoroscopic guidance. Methods: We retrospectively reviewed medical records of 74 patients with nonsmall cell lung cancer (NSCLC) who underwent R-EBUS combined with TBB or TBB alone as a diagnostic technique. Subjects were grouped according to the diagnostic modality used (R-EBUS combined with TBB vs. TBB alone). Each group was matched for age, sex, and location of the biopsy. The chi-square test and paired t-test were used to compare characteristics and identify factors that affected the diagnostic yield. Results: The mean age of the study cohort was 67.4 AE 12.8 years, with 21 (56.8%) men and 16 (43.2%) women in each group. The lesion size was significantly smaller in the R-EBUS group (23.6 vs. 33.9, P < 0.001). The diagnostic yield with the combined use of R-EBUS and TBB (27/37, 72.9%) was significantly higher than that with standard TBB alone (22/37, 59.4%). Lung lesions with a positive bronchus sign were associated with a higher diagnostic yield (odds ratio = 3.52 [1.17-10.62]; P = 0.025). Conclusions: The combination of R-EBUS with TBB resulted in a higher diagnostic yield than either technique alone. Thus, the addition of R-EBUS biopsy would be helpful to improve the diagnostic yield of TBB. Key points Significant findings of the study: The combination of R-EBUS with TBB under fluoroscopic guidance improved the diagnostic yield of PPLs compared to TBB alone. A tissue diagnosis was more likely in pulmonary lesions with the air-bronchus sign. What this study adds: The use of R-EBUS could help improve the low diagnostic yield of TBB under fluoroscopic guidance without increasing the incidence of complications.

Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy

“…5 The use of fluoroscopic guidance in addition to RP-EBUS can improve diagnostic yield while administering acceptable radiation doses to patients and clinicians. [6][7][8] However, fluoroscopy still exposes patients and practitioners to radiation, and consumes additional space, manpower, and costs (e.g., to install a shield room). 9 Few studies have explored the efficacy and safety of RP-EBUS-TBLB using a GS without fluoroscopy for PPLs.…”

Radial Endobronchial Ultrasound to Diagnose a Case of Non-Hodgkin’s Lymphoma in the Lung: A Case Report and Literature Review

“…Our patient had unresolved cough, breathlessness, and fever for 22 days, despite treatment with antibiotics and other supportive medications, due to which we opted to biopsy the lesion using radial EBUS as a navigation tool. Radial-probe EBUS can precisely locate peripheral pulmonary nodules or masses and allows for clear visualization of bronchial and vascular structures, reducing the incidence of complications such as bleeding, while avoiding areas of necrosis to improve diagnostic yield [3,4]. Kurimoto et al [5] classified EBUS patterns into three distinct categories with six subsets, as shown in Table 1.…”

“…A thorough evaluation of suspected cases should include computed tomography (CT) of the thorax to assess and identify potential hilar and mediastinal lymphadenopathy which may prompt further investigation to support the diagnosis of NHL. Radial-probe endobronchial ultrasound (EBUS) has emerged as a widely accepted procedure that can help localize and guide tissue sampling for an accurate diagnosis of peripheral pulmonary nodules [3,4]. Here, we discuss an interesting case of NHL in the lung which presented as a classic case of pneumonia.…”

Diagnosis and Pattern Identification of Intrathoracic Malignant Melanoma Metastasis: A Retrospective Single Center Analysis

“…Furthermore, it can reach many different thoracic nodal stations compared with other diagnostic techniques, also with the concomitant use of the echobronchoscope through the esophagus [ 22 ]. On the other hand, when the pathology involves primarily the lung parenchyma, the endoscopic tool we have is represented by the TBB with different guide systems and instruments (fluoroscopy, radial EBUS, thin and ultrathin scopes, lung navigation systems): this specific technique has evolved through years and has reached higher accuracy also for more peripheral and smaller lung lesion, with an excellent safety profile [ 23 , 24 , 25 ]. Focusing on the other procedures used, MT is another established endoscopic technique with a high diagnostic yield and an excellent safety profile [ 26 ], especially if compared with other diagnostic techniques [ 27 ].…”