Retrospective analysis of radial EBUS outcome for the diagnosis of peripheral pulmonary lesion: sensitivity and complications

Abstract

BackgroundThe purpose of the current study was to clarify the sensitivity and complication rate of the radial (endobronchial ultrasound, EBUS) without the use of guide-sheath (GS) and fluoroscopy for lung cancer (LC), by measuring the distance from the orifice of the bronchus to the pulmonary lesion, as well as to analyze factors that can predict the diagnostic outcome.Materials and methodsA total of 147 patients with peripheral pulmonary lesions (PPL) underwent radial EBUS-guided transbronchial biopsy (TBB) in between August 1, 2013, and August 31, 2014. We analyzed retrospectively radiological data, diagnostic work-up in everyday clinical settings, final diagnosis and complication rates, as well as factors influencing the diagnostic outcome.ResultsAround 63.9% of PPLs were visualized by ultrasound. A definitive malignant diagnosis was established in 39 patients (26.5%) using radial EBUS. In the remaining 108 patients, additional procedures were performed. We missed LC diagnosis in 40 cases that results in a sensitivity of 49%. For malignant lesions visualized by radial EBUS, the sensitivity was 60%, compared with 24% for not visualized lesions. For malignant lesions, logistic regression was performed to identify the factors that had significant influence on visualization of the lesion and on diagnostic yield. Logistic regression analysis showed significant odds ratios (OR) for visualization depending on location of the lesion; upper lobe lesions were identified more frequent with OR of 3.85 (95% CI 1.42 – 10.98, p=0.009). Size above 30 mm had a non-significant OR of 2.11 (95% CI 0.80−5.73, p=0.134) for visualization.Diagnostic yield was only significantly influenced by visualization with the radial EBUS, OR 3.70 (95% CI 1.35−11.02, p=0.014). Location (p=0.745) and size above 30 mm (p=0.308) showed no significant increase in diagnostic yield.Other lesion characteristics defined on computed tomography, such as distance to carina and pleura, did not show any significant influence on the diagnostic yield. The complications rate was low with three cases of pneumothorax.ConclusionRadial EBUS has definitely its place in the diagnostic work-up of PPL, especially for the lesions that can be visualized by radial ultrasound. However, prospective randomized controlled studies are necessary to raise the diagnostic yield and to define factors that can predict the outcome, which will consequently enable selection of the ‘right’ patients for this diagnostic procedure.

Radial‐probe endobronchial ultrasound outcomes in the investigation of peripheral pulmonary lesions: a New Zealand perspective

“…The overall diagnostic yield of radial‐EBUS was 55.9% (95% CI: 44.3–67.9) and the malignant diagnostic sensitivity was 60.8% (95% CI: 46.1–74.2). These figures are consistent with the published literature on radial‐EBUS diagnostic yield which range from 55 to 86%, including a recent large meta‐analysis of 57 studies by Ali et al . reporting a pooled diagnostic yield of 70.5% .…”

“…The overall diagnostic yield of radial-EBUS was 55.9% (95% CI: 44.3-67.9) and the malignant diagnostic sensitivity was 60.8% (95% CI: 46.1-74.2). These figures are consistent with the published literature on radial-EBUS diagnostic yield which range from 55 to 86%, [9][10][11][12][13] including a recent large meta-analysis of 57 studies by Ali et al reporting a pooled diagnostic yield of 70.5%. 3 It is worthwhile noting that some of these studies used additional guidance methods, such as fluoroscopy, curette, virtual bronchoscopy and thin bronchoscope, all of which have the potential of influencing and improving diagnostic yield.…”

Comparison of radial endobronchial ultrasound with a guide sheath and with distance by thin bronchoscopy for the diagnosis of peripheral pulmonary lesions: a prospective randomized crossover trial

“…The diagnostic yield with REBUS-GS (72.2%) was comparable to the diagnostic yields reported in other studies (63.9-72.5%) (13)(14)(15)(16). The diagnostic yield for PPLs with REBUS-D by thin bronchoscope (75.9% in total, 78.9% for MT) in the present study was higher than that the diagnostic yields reported in previous studies with therapeutic bronchoscopy (53% in total, 73% for MT) (6,7).…”

Small lung lesions invisible under fluoroscopy are located accurately by three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields

“…The diagnostic yield has fluctuated from 53% up to 77% [22], which can be increased by ensuring that TBB is performed at the correct location as identified by the EBUS. Tay et al performed a retrospective analysis of 196 consecutive patients who underwent investigation with R-EBUS [23].…”