Radial probe endobronchial ultrasound using a guide sheath for peripheral lung lesions in beginners

Abstract

BackgroundThe diagnostic yields and safety profiles of transbronchial lung biopsy have not been evaluated in inexperienced physicians using the combined modality of radial probe endobronchial ultrasound and a guide sheath (EBUS-GS). This study assessed the utility and safety of EBUS-GS during the learning phase by referring to a database of performed EBUS-GS procedures.MethodsFrom December 2015 to January 2017, all of the consecutive patients who underwent EBUS-GS were registered. During the study period, two physicians with no previous experience performed the procedure. To assess the diagnostic yields, learning curve, and safety profile of EBUS-GS performed by these inexperienced physicians, the first 100 consecutive EBUS-GS procedures were included in the evaluation.ResultsThe overall diagnostic yield of EBUS-GS performed by two physicans in 200 patients with a peripheral lung lesion was 73.0%. Learning curve analyses showed that the diagnostic yields were stable, even when the procedure was performed by beginners. Complications related to EBUS-GS occurred in three patients (1.5%): pneumothorax developed in two patients (1%) and resolved spontaneously without chest tube drainage; another patient (0.5%) developed a pulmonary infection after EBUS-GS. There were no cases of pneumothorax requiring chest tube drainage, severe hemorrhage, respiratory failure, premature termination of the procedure, or procedure-related mortality.ConclusionsEBUS-GS is a safe and stable procedure with an acceptable diagnostic yield, even when performed by physicians with no previous experience.Electronic supplementary materialThe online version of this article (10.1186/s12890-018-0704-7) contains supplementary material, which is available to authorized users.

Feasibility of ultra-low dose CT for bronchoscopy of peripheral lung lesions

“…The presence of a bronchus sign is reportedly a reliable predictor of a successful peripheral bronchoscopy procedure [7,16]. In the current study, the bronchus sign on ultra-low dose CT in groups 1 and 2 was well correlated with the bronchus sign of a standard dose CT scan.…”

“…The technique of bronchoscopy for peripheral lung lesions, or so-called peripheral bronchoscopy, has substantially improved over the past few decades, such that it has become safer and provides an acceptable diagnostic yield [6][7][8]. Interpretation of CT scans without any assistance from expensive navigation equipment (e.g., virtual bronchoscopy navigation and electromagnetic navigation bronchoscopy [9,10]), including identification of the bronchus sign, is considered the most important preparation before bronchoscopy for patients with peripheral lung lesions.…”

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

“…The overall procedure time in both groups was longer than that reported in a previous study . This was because most patients underwent EBUS‐guided transbronchial needle aspiration if mediastinal lymph nodes were noted, adding to the procedural time.…”

Lung Nodule Management: An Interventional Pulmonology Perspective

“…In 2013, an American College of Chest Physicians (ACCP) statement 22 quoted a 73% yield of r-EBUS for diagnosing peripheral lung cancers which led to the recommendation: "In patients suspected of having lung cancer, who have a peripheral lung nodule, and a tissue diagnosis is required due to uncertainty of diagnosis or poor surgical candidacy, r-EBUS is recommended as an adjunct imaging modality (Grade 1C)." While a very safe and feasible technology, 23,24 r-EBUS is far from a complete platform. It involves somewhat blind advancement of the catheter toward the target lesion using the operator's knowledge of airway anatomy and the available imaging (and sometimes fluoroscopy), and lacks a navigation platform to guide the catheter into the appropriate airway.…”