Radial Probe Endobronchial Ultrasound for Peripheral Pulmonary Lesions. A 5-Year Institutional Experience

Chen, Alexander; Chenna, Praveen; Loiselle, Andrea; Massoni, Jennifer; Mayse, Martin L.; Misselhorn, David

doi:10.1513/annalsats.201311-384oc

Cited by 141 publications

(117 citation statements)

References 16 publications

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“…Numerous prior studies observed reducing diagnostic performance of radial probe EBUS with smaller PPL size [2,15,18] and for PPLs of benign aetiology [7,15,19]. Presence of the bronchus sign did not correlate with diagnostic outcome in our cohort of 245 PPLs, despite this being suggested previously by other authors [22,23].…”

Section: Discussioncontrasting

confidence: 59%

“…Given probe position adjacent to the lesion is associated with reduced yield of EBUS [15][16][17][18][19], we reasoned that EMN may provide improved diagnostic outcomes in this scenario. In contrast, probe localisation within the target PPL is associated with a high sensitivity and therefore EMN would not further improve localisation or diagnostic performance for such lesions.…”

Section: Performance Of Bronchoscopymentioning

confidence: 99%

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Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±SD). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield. @ERSpublications EMN after nondiagnostic radial EBUS gives only small incremental gain in visualisation rate and diagnostic yield

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Section: Discussioncontrasting

confidence: 59%

Section: Performance Of Bronchoscopymentioning

confidence: 99%

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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“…Previous studies showed that using TBNA to sample peripheral lesions increased yield (16)(17)(18)(19)(20)(21)(22)(23)(24). When r-EBUS demonstrated an "eccentric" lesion, which is defined as the probe being largely biased toward one side of the lesion without the lesion completely surrounding the probe, TBNA might theoretically be particularly useful, because other techniques such as brush and TBBx might bypass the lesion (25,26). Our data confirmed that peripheral TBNA increases yield, but it also showed that the technique is only being used in approximately 16% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Even then, the use of the EWC means that sampling will be in a very tight cluster. This can be an advantage if r-EBUS shows that the EWC is surrounded by the lesion (i.e., concentric); however, at other times, this tight clustering may be a disadvantage (25,26). Therefore, it is really the aggregate performance of the entire system that drives outcome.…”

Section: Original Articlementioning

confidence: 99%

Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry

Ost¹,

Ernst

Lei

et al. 2016

Am J Respir Crit Care Med

423

349

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Rationale: Advanced bronchoscopy techniques such as electromagnetic navigation (EMN) have been studied in clinical trials, but there are no randomized studies comparing EMN with standard bronchoscopy.Objectives: To measure and identify the determinants of diagnostic yield for bronchoscopy in patients with peripheral lung lesions. Secondary outcomes included diagnostic yield of different sampling techniques, complications, and practice pattern variations.Methods: We used the AQuIRE (ACCP Quality Improvement Registry, Evaluation, and Education) registry to conduct a multicenter study of consecutive patients who underwent transbronchial biopsy (TBBx) for evaluation of peripheral lesions.Measurements and Main Results: Fifteen centers with 22 physicians enrolled 581 patients. Of the 581 patients, 312 (53.7%) had a diagnostic bronchoscopy. Unadjusted for other factors, the diagnostic yield was 63.7% when no radial endobronchial ultrasound (r-EBUS) and no EMN were used, 57.0% with r-EBUS alone, 38.5% with EMN alone, and 47.1% with EMN combined with r-EBUS. In multivariate analysis, peripheral transbronchial needle aspiration (TBNA), larger lesion size, nonupper lobe location, and tobacco use were associated with increased diagnostic yield, whereas EMN was associated with lower diagnostic yield. Peripheral TBNA was used in 16.4% of cases. TBNA was diagnostic, whereas TBBx was nondiagnostic in 9.5% of cases in which both were performed. Complications occurred in 13 (2.2%) patients, and pneumothorax occurred in 10 (1.7%) patients. There were significant differences between centers and physicians in terms of case selection, sampling methods, and anesthesia. Medical center diagnostic yields ranged from 33 to 73% (P = 0.16).Conclusions: Peripheral TBNA improved diagnostic yield for peripheral lesions but was underused. The diagnostic yields of EMN and r-EBUS were lower than expected, even after adjustment.

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“…Many researchers have found that the yield in the central lesion is better than with adjacent lesions. [29] In our series, out of a total of 49 cases, 39 were central while 10 showed an adjacent type image on R-EBUS. However, the yields from these were almost similar at 61.5% for central and 70% for the adjacent type of lesions.…”

Section: Discussionmentioning

confidence: 62%

Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: First case series from India

et al. 2017

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Background:A peripheral, bronchoscopically invisible pulmonary lesion is a diagnostic challenge. Transthoracic needle aspiration has long been the investigation of choice but runs the risk of pneumothorax (up to 44%). Newer technologies like radial endobronchial ultrasound (R-EBUS) offer a safer approach. We present our results of R-EBUS in the diagnosis of bronchoscopically invisible lesions. This is the first large case series from India.Aims:(1) To determine the yield of R-EBUS for the diagnosis of bronchoscopically invisible lesions. (2) To compare the yields of forceps versus cryobiopsies in the diagnosis of these lesions.Setting:Tertiary care cancer center.Design:Prospective study.Methods:Consecutive patients presenting between January and October 2015 with bronchoscopically invisible peripheral pulmonary lesions were included. R-EBUS was used to localize and sample the lesion and the yields were analyzed. Yields of cryo and forceps biopsy were compared where both methods had been used. Data were analyzed using SPSS version 22.Results:A definite diagnosis obtained in 67.3% (37/55) patients with no major complications. No significant difference was found in yield between: (1) small (<3 cm) and large (>3 cm) lesions: (46.2% versus 78.6%, P = 0.38). (2) central and adjacent lesions: 61.5% versus 70%. (3) forceps and cryobiopsy (n = 28, 75% versus 67.9% P = 0.562).Conclusions:R-EBUS is a safe procedure in our setting and its yield is comparable to that reported in literature. The yield of central and adjacent lesions and forceps or cryobiopsy appears similar. Further refinements in the technique could improve yield.

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Radial Probe Endobronchial Ultrasound for Peripheral Pulmonary Lesions. A 5-Year Institutional Experience

Cited by 141 publications

References 16 publications

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry

Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: First case series from India

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