Factors influencing visibility and diagnostic yield of transbronchial biopsy using endobronchial ultrasound in peripheral pulmonary lesions

Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs.

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FACTORS INFLUENCE THE DIAGNOSTIC YIELD OF ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL BIOPSY IN PERIPHERAL PULMONARY LESIONS

Respirology ◽

10.1111/resp.13420_32 ◽

2018 ◽

Vol 23 ◽

pp. 101-102

Keyword(s):

Diagnostic Yield ◽

Transbronchial Biopsy ◽

Endobronchial Ultrasound ◽

Ultrasound Guided ◽

Pulmonary Lesions ◽

Peripheral Pulmonary Lesions

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Radial endobronchial ultrasound-guided transbronchial biopsy for peripheral pulmonary malignancy: biopsy- or brushing-first?

BMC Pulmonary Medicine ◽

10.1186/s12890-019-0961-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Chun-Ta Huang ◽

Yi-Ju Tsai ◽

Chao-Chi Ho ◽

Chong-Jen Yu

Keyword(s):

Diagnostic Yield ◽

Transbronchial Biopsy ◽

Endobronchial Ultrasound ◽

Current Evidence ◽

Diagnostic Strategy ◽

Safety Signal ◽

Pulmonary Lesions ◽

Bronchial Brushing ◽

Peripheral Pulmonary Lesions ◽

The Impact

Abstract Background Radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy (TBB) is a common diagnostic modality for peripheral pulmonary lesions; however, there is uncertainty about the optimal sequence of TBB and bronchial brushing during the procedure. Thus, we aimed to investigate whether a biopsy-first or brushing-first strategy confers a better diagnostic yield and safety signal for R-EBUS-guided procedures for peripheral pulmonary malignancy. Methods From January 2017 to June 2018, consecutive patients referred for R-EBUS-guided TBB and bronchial brushing of peripheral pulmonary lesions and with a final malignant diagnosis were included. Patients were placed in a biopsy-first (biopsy followed by brushing) or a brushing-first (brushing followed by biopsy) group. The outcomes of interest were the diagnostic yield and complication profile of the procedures. Multivariate logistic regression and subgroup analysis were used to assess the impact of the procedure strategy. Results A total of 438 patients were included and the diagnostic yield of R-EBUS-guided TBB plus brushing for peripheral pulmonary malignancy was 73%. The diagnostic yield was associated with the solid lesion appearance (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.08–3.75) and R-EBUS probe position within the lesion (OR 1.92; 95% CI 1.08–3.42), and the yield rates were comparable between the biopsy-first and brushing-first strategies. Moreover, the safety signal did not differ between the two groups. Conclusions The two procedure strategies were indistinguishable in terms of diagnostic efficacy and adverse events for patients with peripheral pulmonary malignancy. Current evidence indicates that in patients with peripheral pulmonary lesions suspected of being malignant, either biopsy-first or brushing-first is a viable and acceptable diagnostic strategy during R-EBUS-guided procedures.

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Guide sheath versus non-guide sheath method for endobronchial ultrasound-guided biopsy of peripheral pulmonary lesions: A multicenter randomized trial

European Respiratory Journal ◽

10.1183/13993003.01678-2021 ◽

2021 ◽

pp. 2101678

Author(s):

Masahide Oki ◽

Hideo Saka ◽

Tatsuya Imabayashi ◽

Daisuke Himeji ◽

Yoichi Nishii ◽

...

Keyword(s):

Randomized Trial ◽

Primary Endpoint ◽

Diagnostic Yield ◽

Transbronchial Biopsy ◽

Endobronchial Ultrasound ◽

Ultrasound Guided ◽

Pulmonary Lesions ◽

Multicenter Randomized Trial ◽

Median Diameter ◽

Peripheral Pulmonary Lesions

IntroductionGuide sheaths (GSs) have been widely used during radial probe endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) of peripheral pulmonary lesions. However, it remains unknown whether a GS enhances the diagnostic yield. We compared the diagnostic yields of small peripheral pulmonary lesions between rEBUS-TBB with and without a GS.MethodsIn eight institutions, patients with peripheral pulmonary lesions≤30 mm in diameter were enrolled and randomized to undergo rEBUS-TBB with a GS (GS group) or without a GS (non-GS group) using a 4.0-mm thin bronchoscope, virtual bronchoscopic navigation, and fluoroscopy. The primary endpoint was the diagnostic yield of the histology specimens.ResultsA total of 605 patients were enrolled; ultimately, data on 596 (300 in the GS group and 296 in the non-GS group) with peripheral pulmonary lesions having a longest median diameter of 19.6 mm were analyzed. The diagnostic yield of histological specimens from the GS group was significantly higher than that from the non-GS group (55.3% versus 46.6%, respectively; p=0.033). Interactions were evident between the diagnostic yields, procedures, lobar locations (upper lobe versus other regions, p=0.003), and lesion texture (solid versus part-solid nodules, p=0.072).ConclusionsThe diagnostic yield for small peripheral pulmonary lesions afforded by rEBUS-TBB using a GS was higher than that without a GS.

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Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions

Respiration ◽

10.1159/000515181 ◽

2021 ◽

pp. 1-9

Author(s):

Kai-Lun Yu ◽

Shun-Mao Yang ◽

Huan-Jang Ko ◽

Hui-Yu Tsai ◽

Jen-Chung Ko ◽

...

Keyword(s):

Computed Tomography ◽

Propensity Score ◽

Cone Beam Computed Tomography ◽

Diagnostic Yield ◽

Endobronchial Ultrasound ◽

Cone Beam ◽

Complication Rates ◽

Efficacy And Safety ◽

Pulmonary Lesions ◽

Peripheral Pulmonary Lesions

Background: The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated. Objectives: The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. Methods: We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety. Results: While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; p = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; p = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; p = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm2, respectively. Conclusions: TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

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The Diagnostic Yield of Endobronchial Ultrasound With a Guide Sheath in Small Peripheral Pulmonary Lesions

CHEST Journal ◽

10.1378/chest.9431 ◽

2010 ◽

Vol 138 (4) ◽

pp. 845A

Author(s):

Jamsak Tscheikuna ◽

Supawadee Makanut ◽

Supparerk Disayabutr

Keyword(s):

Diagnostic Yield ◽

Endobronchial Ultrasound ◽

Pulmonary Lesions ◽

Peripheral Pulmonary Lesions

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Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions

Thoracic Cancer ◽

10.1111/1759-7714.13446 ◽

2020 ◽

Vol 11 (6) ◽

pp. 1639-1646

Author(s):

Sojung Park ◽

Hee‐Young Yoon ◽

Yeji Han ◽

Kyung Sook Wang ◽

So Young Park ◽

...

Keyword(s):

Lung Biopsy ◽

Diagnostic Yield ◽

Transbronchial Lung Biopsy ◽

Endobronchial Ultrasound ◽

Pulmonary Lesions ◽

Peripheral Pulmonary Lesions

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Diagnostic Value of a New Cryoprobe for Peripheral Pulmonary Lesions: A Prospective Study

10.21203/rs.3.rs-1010979/v1 ◽

2021 ◽

Author(s):

Midori Tanaka ◽

Yuji Matsumoto ◽

Tatsuya Imabayashi ◽

Takuya Kawahara ◽

Takaaki Tsuchida

Keyword(s):

Prospective Study ◽

Diagnostic Yield ◽

Diagnostic Value ◽

Lesion Size ◽

Endobronchial Ultrasound ◽

Pulmonary Lesions ◽

Single Use ◽

Peripheral Pulmonary Lesions ◽

A Prospective Study ◽

Established Technique

Abstract Background: Cryobiopsy is an established technique that yields larger and higher-quality samples than does a forceps biopsy. However, it remains underutilised in the diagnosis of peripheral pulmonary lesions (PPLs), mainly because of difficulties in handling conventional cryoprobes. A recently introduced single-use cryoprobe with a smaller diameter and more flexibility than conventional ones may improve its diagnostic ability for PPLs. We conducted this prospective study to evaluate the feasibility of transbronchial cryobiopsy in the diagnoses of PPLs, using a new 1.7-mm cryoprobe. Methods: The study included patients with PPLs less than 30 mm in diameter scheduled to undergo bronchoscopy. All the procedures were performed using a combination of virtual bronchoscopic navigation, radial endobronchial ultrasound (R-EBUS) and X-ray fluoroscopy, and all the samples were collected using the cryoprobe alone. Thereafter, we assessed the diagnostic outcomes and safety profiles.Results: A total of 50 patients were enrolled and underwent cryobiopsy. The median lesion size was 20.8 mm (range, 8.2–29.6 mm), and the negative bronchus sign was seen in 34% of lesions. The diagnostic yield was 94% (95% confidence interval, 83.5–98.8%). A positive bronchus sign had a significantly higher diagnostic yield than did a negative bronchus sign (100% vs. 82.4%; P=0.035). The yield was achieved regardless of other variables, including lesion size, location, and R-EBUS findings. The major complications were mild and moderate bleeding in 28% and 62% of patients, respectively. Pneumothorax was identified in one patient.Conclusion: Transbronchial cryobiopsy using the new 1.7-mm cryoprobe is a feasible procedure that has the potential to increase the diagnostic accuracy for PPLs.Trial Registration: Japan Registry of Clinical Trials, jRCT1032200065. Registered 8 July 8 2020, https://jrct.niph.go.jp/en-latest-detail/jRCT1032200065

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