Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

Abstract

Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ∓ 0.7 cm) and 19 masses (mean diameter, 4.1 ∓ 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions

“…Finally, auxiliary bronchoscopic procedures, such as fluoroscopy or a guide sheath, were not conducted on our study subjects. Since adding these modalities to rEBUS-guided TBB may help achieve a rather favorable diagnostic yield in PPLs, [ 17 , 18 ] it is uncertain whether our findings remain valid when ancillary tools are coupled to rEBUS-guided procedures.…”

The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta‐analysis

“…Early diagnosis of pulmonary lesions is of great importance to reduce mortality due to lung cancer . When endobronchial lesions can be directly visualized by flexible bronchoscopes, peripheral pulmonary lesions (PPLs), generally defined as lesions surrounded by normal pulmonary parenchyma without any computed tomography (CT) evidence of endobronchial abnormalities, are unlikely to be detected by ordinary bronchoscopes . Transthoracic needle aspiration (TTNA) has been recommended for nonsurgical diagnosis of PPLs with a sensitivity of 90%, but the relatively high risk of pneumothorax and other complications has limited its application, in particular when PPLs are small or located far from the chest .…”

Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

“…In addition, the prevalence of neoplasia, a relevant factor for the analysis of the diagnostic yield, 2 was not informed; nor was the final diagnosis of the 12 radial-probe EBUS-invisible pulmonary lesions. Therefore, the presentation of results by Jacomelli et al 1 differs in some aspects from that of important publications on the subject. 2 , 3 …”

“…Finally, we must emphasize the importance of the article by Jacomelli et al, 1 because, in addition to being the first one on radial-probe EBUS in Brazil, it is an example of use of the growing arsenal of endoscopic tools for the investigation and treatment of pulmonary lesions.…”

“…We would like to make some comments regarding the article by Jacomelli et al, 1 which describes an initial experience using radial-probe endobronchial ultrasound (EBUS) for the investigation of 51 pulmonary lesions.…”