Value of radial probe endobronchial ultrasound-guided transbronchial biopsy and computer tomography-guided transthoracic needle aspiration in the diagnosis of peripheral pulmonary lesions

Abstract

Computer tomography-guided transthoracic needle aspiration (CT-TTNA) is a minimally invasive technique for sampling peripheral lung lesions. Radial endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) is an alternative. The present study analyzed and compared rEBUS-TBB and CT-TTNA in the diagnosis of peripheral pulmonary lesions (PPL).Clinical data of 513 patients with PPL who underwent an rEBUS-TBB or CT-TTNA examination were analyzed retrospectively. The positive diagnostic rate, complication rate, and influencing factors of the 2 methods were compared.The positive diagnostic rate and complication rate were significantly higher in CT-TTNA than rEBUS-TBB (P = .001; P < .001, respectively). The rEBUS-TBB group showed a higher positive diagnostic rate in larger lesions (>2 cm) than in smaller (≤2 cm) (P = .012), and was lower in the lesions proximal to the chest wall than those distally located (P = .046); no significant difference was observed in the different pulmonary segments (P = .109). In the CT-TTNA group, the positive diagnostic rate in larger lesions did not differ significantly than the smaller lesions (P = .05); it differed significantly in different segments (P = .044). The incidence of pneumothorax was lower in lesions proximal to the chest wall than those located distally (P = .037). In the rEBUS-TBB group, the success rate of the exploration and biopsy of the lesions was 87.4%; the rate of exploration of larger lesions and with bronchial sign was higher than smaller lesions and without bronchial sign (P < .001; P < .001, respectively) while that of lesions close to the chest wall was lower than those distally located (P = .006).rEBUS-TBB and CT-TTNA are effective and safe in the diagnosis of PPL. The positive diagnostic rate of CT-TTNA is higher than rEBUS-TBB. The incidence of pneumothorax in CT-TTNA is higher than rEBUS-TBB. CT-TTNA is selected for smaller lesions close to the chest wall; rEBUS-TBB is used for lesions larger, distal from the chest wall or with a bronchial sign.

Diagnostic value and safety of color doppler ultrasound-guided transthoracic core needle biopsy of thoracic disease

“…To our knowledge, this is the first study of color Doppler US-guided transthoracic biopsy entirely using CNB with a high diagnosis accuracy. Many studies have shown that color Doppler US-guided transthoracic FNAB is useful and safe in the diagnosis of peripheral pulmonary lesions [2,17]. In this retrospective observational study in patients with peripheral pulmonary, chest wall and mediastinal lesions, we performed color Doppler US-guided transthoracic CNB with a freehand technique using automated biopsy guns.…”

“…As reported in the literature, US-guided biopsy has many advantages over CT in cases of lesions in the pulmonary periphery or mediastinum that are potentially approachable with US guidance [17,24]. When radiography is contraindicated, US has clear advantages.…”

Analysis of indications for pulmonary peripheral lesions diagnosed using radial endobronchial ultrasound‑guided transbronchial lung biopsy

“…In ideal situations, all lesions in the pulmonary field should be detectable. However, the diagnostic ability of rEBUS-TBLB was lower compared with percutaneous transthoracic biopsy (25). In clinical practice, the positive diagnostic rate of rEBUS-TBLB was significantly lower in bronchiolar segments compared with others.…”

Endobronchial ultrasound‐guided versus computed tomography‐guided biopsy for peripheral pulmonary lesions: A meta‐analysis

“…While the CT‐TTNB approach achieved exhibited diagnostic performance when evaluating PPLs, the EBUS‐TBB approach was associated with lower complication rates. Indeed, lower complication rates were associated with the EBUS‐TBB approach in all included studies 10,13‐20 . CT‐TTNB was commonly associated with complications including pneumothorax and hemorrhage.…”