Diagnostic yield of endobronchial ultrasound and virtual CT navigational bronchoscopy for biopsy of pulmonary nodules, mediastinal lymph nodes, and thoracic tumors in children

Abstract

ObjectiveEndobronchial ultrasound‐guided transbronchial biopsy and needle aspiration (EBUS‐TBB/EBUS‐TBNA) are first line investigative modalities for lung and mediastinal pathology in adults. We aimed to characterize and assess the diagnostic yield of EBUS and virtual CT navigation guided biopsies in children.Study DesignThis single center, retrospective cohort study included patients who underwent radial or linear EBUS procedures (+/− CT navigation) for biopsy of mediastinal lymph nodes, tumors, and pulmonary nodules. Demographic, procedural, and outcome were collected.ResultsSixty procedures were performed in 56 patients aged 2–22 years of age between January 2015 and May 2023. The most common indications for biopsy were pulmonary nodules (45%) and hilar/mediastinal lymphadenopathy (33%). For cases in which a final diagnosis was ascertained by any means, the diagnostic yield for linear EBUS (mediastinal pathology) was 76% and the diagnostic yield from radial EBUS (pulmonary nodules and lung masses) was 85%. The most common diagnoses were infection (45%), malignancy (17%), and sarcoidosis (11%). Among patients in whom infection was the final diagnosis, a total of 31 pathogens were identified. Eighteen were identified on bronchoalveolar lavage and an additional 14 pathogens identified on EBUS‐TBB, representing an increase of 77% (p < .005). The sensitivity, specificity, negative and positive predictive values for malignancy detection were 73%, 100%, 94%, and 100%, respectively.ConclusionEBUS‐TBB/TBNA is a safe and effective way to diagnose lung and mediastinal pathology in children. Pediatric interventional pulmonology is a growing field offering minimally‐invasive diagnostic opportunities for children in whom more invasive procedures were previously the only option.

Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States

“…Additionally, certain adult IP procedures are standard of care for other pediatric disciplines such as rigid bronchoscopy and tracheostomy for ENT, thoracoscopy for general surgery, pleural catheter placement for PICU and image guided thoracostomy tube placement for interventional radiology and should remain so. As discussed in several case series, pediatric IP procedures can provide a feasible and safe noninvasive alternative in cases where open procedures are currently the only available option 1,6,23,24 …”

“…While there are many case series reports and descriptive retrospective cohort studies on pediatric advanced and interventional bronchoscopy, 8,9,11,23,28,29 further research is needed to determine how to maximize diagnostic yield for nonmalignant disease and increase understanding around which nonmalignant diseases are best assessed with a transbronchial approach. The use of endobronchial valves in pediatric patients for persistent air leak is another area in need of further research.…”