Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions

Kikuchi, Eiki; Yamazaki, Koichi; Sukoh, Noriaki; Kikuchi, Jyunko; Asahina, Hajime; Imura, Masataka; Onodera, Yuya; Kurimoto, Noriaki; Kinoshita, I; Nishimura, Masaharu

doi:10.1183/09031936.04.00138603

Cited by 194 publications

(173 citation statements)

References 25 publications

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“…Several studies [5][6][7][8][9][10][11][12] have reported on the efficacy and safety of EBUS-guided transbronchial biopsy. However, no trial has specifically addressed the yield in patients with nodules of f20 mm in diameter.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm

Eberhardt¹,

Ernst²,

Herth³

2009

Eur Respir J

105

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Transbronchial biopsy of solitary pulmonary nodules (SPNs) is usually performed under fluoroscopic guidance, but success varies widely. Endobronchial ultrasonography (EBUS) may increase the likelihood of success. The ability of EBUS-guided transbronchial biopsy to sample SPNs of ,20 mm in diameter was assessed.All patients seen between June 2004 and August 2007 in whom computed tomography identified a SPN of ,20 mm underwent bronchoscopic general anaesthesia or moderate sedation for a radial EBUS-guided examination. If a typical ultrasonographic picture of solid tissue could be identified, specimens were taken through a catheter with forceps. If the node was not detected within 20 min, the procedure was terminated.Of 100 nodules detected in 100 consecutive patients, 67 (mean diameter 15 mm) were visualised using EBUS and biopsy specimens taken. A diagnosis was established for 46 (46%) patients. If the lesion was visualised by EBUS, the diagnostic success was 69% (46 out of 67). The 33 patients whose nodules could not be sampled underwent surgical biopsy. Pneumothorax occurred in three patients.For SPNs of ,20 mm that can be detected using ultrasound, EBUS-guided transbronchial biopsy is safe and effective.

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Section: Discussionmentioning

confidence: 99%

“…Several articles have reported the success of EBUS-guided transbronchial biopsy in SPNs [5][6][7][8][9][10][11][12], but, in the most of these trials, SPNs of ,20 mm in diameter were not examined.…”

mentioning

confidence: 99%

Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm

Eberhardt¹,

Ernst²,

Herth³

2009

Eur Respir J

105

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“…The following studies reported that the diagnostic yield of EBUS-GS for PPLs was between 57% and 90%, and it was proved to be a safe procedure with low rate of pneumothorax and hemoptysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Till now there is only one randomized controlled study (22) comparing the two procedures.…”

Section: Introductionmentioning

confidence: 99%

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

et al. 2016

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Background: Computed tomography guided transthoracic needle aspiration (CT-TTNA) and endobronchial ultrasonography with guide sheath (EBUS-GS) transbronchial lung biopsy are important methods for the diagnosis of peripheral pulmonary lesions (PPLs). Without enough evidence, it is controversial which is a better choice for diagnosing PPLs. In this study, we hypothesized that the complication rate of EBUS-GS would be lower than CT-TTNA and the diagnostic accuracy of EBUS-GS were not inferior to CT-TTNA. Methods: This study was a retrospective analysis of a prospective registry with propensity matching.Patients with PPLs were divided into EBUS-GS group and CT-TTNA group according to patients' intent to treatment. Pathological results and procedure related complications of EBUS-GS and CT-TTNA were recorded. Propensity score matching(PSM) was used to eliminate the intergroup bias. Diagnostic yields and complications of two groups were compared. Subgroup analysis was performed to conclude the indications of different procedures. Results: A total of 187 patients (CT-TTNA: 130; EBUS-GS: 57) were enrolled. After propensity score matching, 54 paired patients were included. Diagnostic yield was 81% (44/54) for EBUS-GS and 87% (47/54) for CT-TTNA (P=0.43), respectively. Diagnostic sensitivity in malignancy was 93% (42/45) for CT-TTNA and 79% (37/47) for EUBS-GS (P=0.04). Subgroup analysis revealed that the sensitivity of CT-TTNA was significantly higher in diagnosing of lesions close to the chest wall (100% vs. 80%, P=0.04), and bronchus sign on CT was a predictive factor for accurate diagnosis by EBUS-GS. The overall complication rate was 13% (7/54) for CT-TTNA group, which was not significantly higher than that of EBUS-GS group (2%, P=0.06). Subgroup analysis showed that patients combined with pulmonary comorbidities and lesions apart from chest wall were risk factors for complications of CT-TTNA. Conclusions: Both of the two procedures are effective for the diagnosis of PPLs, but CT-TTNA has a higher diagnostic sensitivity for malignancy. EBUS-GS has fewer complications, and it is more suitable for patients combined with pulmonary comorbidities and lesions with bronchus signs.

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“…The number of applications for FOB procedures in elderly patients will likely grow tremendously in the near future with expanding applications in clinical medicine [11] and research [12][13][14]. In particular, the role of FOB procedures in lung cancer continues to expand.…”

Section: Introductionmentioning

confidence: 99%

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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Aim. To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. Methods. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older (“very elderly”; =>75 yrs), were reviewed. Results. Patients aged 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged <75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively.Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Conclusions. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.

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Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions

Cited by 194 publications

References 25 publications

Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm

Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

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