Utility of Radial Probe Endobronchial Ultrasound Guided Transbronchial Lung Biopsy in Bronchus Sign Negative Peripheral Pulmonary Lesions

Abstract

Background The presence of the bronchus sign on chest computed tomography is associated with an increased diagnostic yield of radial probe endobronchial ultrasound–guided transbronchial lung biopsy (RP-EBUS-TBLB). However, the utility of RP-EBUS-TBLB for bronchus sign negative peripheral pulmonary lesions (PPLs) remains unknown. We investigated the utility of RP-EBUS-TBLB in bronchus sign negative PPLs. Methods We retrospectively reviewed data from 109 patients who underwent RP-EBUS for bronchus sign negative PPLs from January 2019 to August 2020. TBLB was performed using RP-EBUS with a guide sheath and without fluoroscopy. The EBUS visualization and TBLB diagnostic yields were assessed. Multivariable logistic regression analyses were used to identify factors affecting the EBUS visualization and diagnostic yields. Results The EBUS visualization yield was 74.1% (68/109). Of the 109 lung lesions, 92 were definitively diagnosed. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 50.5% (55/109), 34.9% (29/83), 100% (26/26), 100% (29/29), and 32.5% (26/80), respectively. In multivariable analyses, the size of the lesion (≥ 20 mm; odds ratio [OR], 2.62; 95% confidence interval [CI], 1.16–5.93; P = 0.021) and the distance from the pleura (> 10 mm; OR, 2.37; 95% CI, 1.02–5.52; P = 0.045) were associated with EBUS visualization. Regarding diagnostic yield, having the probe within the lesion (OR, 28.50; 95% CI, 6.26–129.85; P < 0.001) and a solid lesion (OR, 14.58; 95% CI, 2.64–80.38; P = 0.002) were associated with diagnostic success. Pneumothorax and hemoptysis occurred in 3.7% (4/109) and 0.9% (1/109), respectively, of the patients. Conclusion RP-EBUS-TBLB using a GS can be considered a diagnostic method in bronchus sign negative solid PPLs. Having the probe within the lesion and a solid lesion were important for diagnostic success. Complication rates were acceptable.

Computed Tomography Bronchus Sign Subclassification during Radial Endobronchial Ultrasound-Guided Transbronchial Biopsy: A Retrospective Analysis

“…In CT-BS group II, a solid lesion was an independent factor affecting diagnostic success, in addition to rEBUS and fluoroscopic visualization as in group I. This was similar to that reported in a previous study [ 34 ]. CT-BS group II was classified into two or four types in the literature.…”

“…Despite minor differences in classification, Tsuboi type III, CT-BS 1 reported by Tokoro et al, type B reported by Minezawa et al, and CT signs type 2 reported by Shinagawa et al corresponded to bronchus type IIa in this study [ 10 , 18 , 19 , 20 , 21 ]. This type is typically classified as positive CT-BS [ 10 , 16 , 21 , 23 , 32 ], while studies focusing on negative CT-BS are considered negative [ 34 , 35 ], with a diagnostic yield ranging from 37.9% to 74.1%. Among CT-BS group II types, type IIa has a higher rEBUS visualization yield [ 20 , 34 ]; however, it contains many “adjacent to” images with comparable diagnostic performance relative to other types [ 36 ] or intermediate to CT-BS group I [ 20 , 21 ].…”

“…This type is typically classified as positive CT-BS [ 10 , 16 , 21 , 23 , 32 ], while studies focusing on negative CT-BS are considered negative [ 34 , 35 ], with a diagnostic yield ranging from 37.9% to 74.1%. Among CT-BS group II types, type IIa has a higher rEBUS visualization yield [ 20 , 34 ]; however, it contains many “adjacent to” images with comparable diagnostic performance relative to other types [ 36 ] or intermediate to CT-BS group I [ 20 , 21 ].…”

“…Previous reports classified positive and negative CT-BS into two categories: types Ia-Ic/IIa and IIb/IIc, respectively [ 10 , 16 , 21 , 23 , 32 ] or group I and group II [ 34 , 35 ]. Based on the results of this study, it would be appropriate to classify CT-BS positive and negative into two groups I and II.…”

Application of Precise Positioning for Sputum Expectoration in ICU Patients with Pulmonary Infection

“…Precise positioning for sputum expectoration is a nursing operation that focuses on expectoration in the specific location and range of sputum accumulation area, atelectasis area, or lung lesions based on dynamic combination of lung ultrasound examination results, which can be targeted for sputum removal and more effectively remove sputum in the infected area, thus reducing the severity of PI. In addition, by reducing sputum accumulation, it can promote lung recruitment maneuvers and further improve PF [ 13 , 14 ]. In this study, the sputum volume was less, and the respiratory frequency and CPIS score were lower in the observation group versus the control group after 7 days of intervention, indicating that the application of precise positioning for sputum expectoration for the nursing of ICU patients with PI could reduce the sputum excretion and the severity of PI.…”