Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy

  • Hong, Kyung Soo (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Ahn, Heeyun (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Lee, Kwan Ho (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Chung, Jin Hong (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Shin, Kyeong-Cheol (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Jin, Hyun Jung (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Jang, Jong Geol (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Lee, Seok Soo (Department of Thoracic and Cardiovascular Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Jang, Min Hye (Department of Pathology, Yeungnam University College of Medicine) ;
  • Ahn, June Hong (Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine)
  • Received : 2021.01.02
  • Accepted : 2021.06.23
  • Published : 2021.10.31
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Abstract

Background: Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. In this study, we investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs. Methods: We retrospectively reviewed data from 607 patients who underwent RP-EBUS of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS without fluoroscopy. The diagnostic yield and complications were assessed. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields. Results: The overall diagnostic accuracy was 76.1% (462/607). In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.27-3.33; p=0.003), positive bronchus sign in chest computed tomography (OR, 2.30; 95% CI, 1.40-3.78; p=0.001), a solid lesion (OR, 2.40; 95% CI, 1.31-4.41; p=0.005), and an EBUS image with the probe within the lesion (OR, 6.98; 95% CI, 4.38-11.12; p<0.001) were associated with diagnostic success. Pneumothorax occurred in 2.0% (12/607) of cases and chest tube insertion was required in 0.5% (3/607) of patients. Conclusion: RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method in diagnosing PPLs that does not involve radiation exposure and has acceptable complication rates.

Keywords

Acknowledgement

This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT (grant number 2021M3E5D1A0201526521 and 2021R1C1C100950811).

References

  1. Ahn JH. An update on the role of bronchoscopy in the diagnosis of pulmonary disease. Yeungnam Univ J Med 2020;37:253-61. https://doi.org/10.12701/yujm.2020.00584
  2. Ali MS, Trick W, Mba BI, Mohananey D, Sethi J, Musani AI. Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: a systematic review and metaanalysis. Respirology 2017;22:443-53. https://doi.org/10.1111/resp.12980
  3. Sainz Zuniga PV, Vakil E, Molina S, Bassett RL Jr, Ost DE. Sensitivity of radial endobronchial ultrasound-guided bronchoscopy for lung vancer in patients with peripheral pulmonary lesions: an updated meta-analysis. Chest 2020;157:994-1011. https://doi.org/10.1016/j.chest.2019.10.042
  4. Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011;37:902-10. https://doi.org/10.1183/09031936.00075310
  5. Kurimoto N, Miyazawa T, Okimasa S, Maeda A, Oiwa H, Miyazu Y, et al. Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest 2004;126:959-65. https://doi.org/10.1378/chest.126.3.959
  6. Steinfort DP, Einsiedel P, Irving LB. Radiation dose to patients and clinicians during fluoroscopically-guided biopsy of peripheral pulmonary lesions. Respir Care 2010;55:1469-74.
  7. Lee SC, Kim EY, Chang J, Lee SH, Han CH. Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer. Thorac Cancer 2020;11:1533-40. https://doi.org/10.1111/1759-7714.13425
  8. Casutt A, Prella M, Beigelman-Aubry C, Fitting JW, Nicod L, Koutsokera A, et al. Fluoroscopic-guided radial endobronchial ultrasound without guide sheath for peripheral pulmonary lesions: a safe and efficient combination. Arch Bronconeumol 2015;51:338-43. https://doi.org/10.1016/j.arbres.2014.09.017
  9. Lee K. New wine into new wineskins: radial endobronchial ultrasound for parenchymal lung infiltration. Tuberc Respir Dis 2019;82:264-5. https://doi.org/10.4046/trd.2019.0042
  10. Yoshikawa M, Sukoh N, Yamazaki K, Kanazawa K, Fukumoto S, Harada M, et al. Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without X-ray fluoroscopy. Chest 2007;131:1788-93. https://doi.org/10.1378/chest.06-2506
  11. Eberhardt R, Anantham D, Ernst A, Feller-Kopman D, Herth F. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 2007;176:36-41. https://doi.org/10.1164/rccm.200612-1866OC
  12. Minezawa T, Okamura T, Yatsuya H, Yamamoto N, Morikawa S, Yamaguchi T, et al. Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study. BMC Med Imaging 2015;15:21. https://doi.org/10.1186/s12880-015-0060-5
  13. Zhu J, Tang F, Gu Y. A prospective study on the diagnosis of peripheral lung cancer using endobronchial ultrasonography with a guide sheath and computed tomography-guided transthoracic needle aspiration. Ther Adv Med Oncol 2018;10:1758834017752269. https://doi.org/10.1177/1758834017752269
  14. Tay JH, Irving L, Antippa P, Steinfort DP. Radial probe endobronchial ultrasound: factors influencing visualization yield of peripheral pulmonary lesions. Respirology 2013;18:185-90.
  15. Minami D, Takigawa N, Morichika D, Kubo T, Ohashi K, Sato A, et al. Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for diagnosis of lung cancer. Respir Investig 2015;53:93-7. https://doi.org/10.1016/j.resinv.2014.10.003
  16. Kikuchi E, Yamazaki K, Sukoh N, Kikuchi J, Asahina H, Imura M, et al. Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions. Eur Respir J 2004;24:533-7. https://doi.org/10.1183/09031936.04.00138603
  17. Asahina H, Yamazaki K, Onodera Y, Kikuchi E, Shinagawa N, Asano F, et al. Transbronchial biopsy using endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation. Chest 2005;128:1761-5. https://doi.org/10.1378/chest.128.3.1761
  18. Boonsarngsuk V, Kanoksil W, Laungdamerongchai S. Comparison of diagnostic performances among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions. J Thorac Dis 2015;7:697-703. https://doi.org/10.3978/j.issn.2072-1439.2015.04.31
  19. Chen A, Chenna P, Loiselle A, Massoni J, Mayse M, Misselhorn D. Radial probe endobronchial ultrasound for peripheral pulmonary lesions: a 5-year institutional experience. Ann Am Thorac Soc 2014;11:578-82. https://doi.org/10.1513/AnnalsATS.201311-384OC
  20. Hayama M, Izumo T, Matsumoto Y, Chavez C, Tsuchida T, Sasada S. Complications with endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions. Respiration 2015;90:129-35. https://doi.org/10.1159/000431383