Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

Abstract

BackgroundRadial probe endobronchial ultrasound (R-EBUS), is effective for tissue diagnosis of lung lesions. We evaluated the diagnostic performance of R-EBUS both a guide-sheath and fluoroscopy and identified factors associated with accurate diagnosis. The feasibility of molecular and genetic testing, using specimens obtained by R-EBUS, was also investigated.MethodsThe study retrospectively reviewed 211 patients undergoing R-EBUS without a guide-sheath and fluoroscopy, June 2016-May 2017. After excluding 27 patients of which the target lesion was not reached, 184 were finally included. Multivariate logistic regression was used, to identify factors associated with accurate diagnosis.ResultsAmong 184 patients, R-EBUS-guided biopsy diagnosed malignancy in 109 patients (59%). The remaining 75 patients (41%) with non-malignant results underwent additional work-ups, and 34 were diagnosed with malignancy. Based on final diagnosis, diagnostic accuracy was 80% (136/170), and sensitivity and specificity for malignancy were 76% (109/143) and 100% (27/27), respectively. In multivariate analysis, peripheral location (adjusted odds ratio [aOR], 3.925; 95% confidence interval [CI], 1.203–12.811; p=0.023), and central position of the probe (aOR, 2.435; 95% CI, 1.424–7.013; p=0.035), were associated with accurate diagnosis of malignancy. Molecular and genetic analyses were successful, in all but one case, with inadequate specimens.ConclusionR-EBUS-guided biopsy without equipment, is effective for tissue diagnosis. Peripheral location and central position of the radial probe, were crucial for accurate diagnosis. Performance of molecular and genetic testing, using samples obtained by R-EBUS, was satisfactory.

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

“…In most previous studies, a solid lesion was not associated with diagnostic success in RP-EBUS-TBLB in multivariable logistic regression analyses. 7 11 15 16 17 Although not statistically significant, solid lesions tended to have higher EBUS visualization in our study. We think that this is why a solid lesion was related to diagnostic success in the present study.…”

“…The complications of the procedures were comparable to those reported in previous studies conducted mainly in patients with bronchus sign positive PPLs. 7 11 12 To the best of our knowledge, this is the first study focusing on the utility of RP-EBUS-TBLB in bronchus sign negative PPLs.…”

“…The diagnostic yields of RP-EBUS in bronchus sign positive and negative peripheral pulmonary lesions (PPLs) on CT scan were 76.5% (95% CI, 65.9–85.6%) and 52.4% (95% CI, 37.6–67.0%), respectively. 5 6 7 Until now, no study has focused on the utility of RP-EBUS guided transbronchial lung biopsy (RP-EBUS-TBLB) in bronchus sign negative PPLs on thin-section CT. In this study, we evaluated the EBUS visualization and diagnostic yield of RP-EBUS in bronchus sign negative PPLs and identified the factors associated with the EBUS visualization yield and diagnostic yield.…”

Feasibility of comprehensive genotyping specimens from radial endobronchial ultrasonography and electromagnetic navigation bronchoscopy

“…These results appear slightly above what is usually reported [6,7,11], likely in part linked to a high median size of the lesions (32 mm), the systematic use of the guidesheath with rEBUS, and the learning curve of a technique widely used in our institution since 2014. The sensitivity is higher in our experience for rEBUS (85.4%) compared with EMN (57.1%), a technology we only use for complex situations (twisted path to reach the lesion, ground glass nodules (less visible in ultrasonography [12]) and smaller nodules (median 16 mm compared to 32 mm for rEBUS in our cohort)).…”

Radial probe endobronchial ultrasound‐guided transbronchial lung biopsy for the diagnosis of cavitary peripheral pulmonary lesions

“…One study reported that specimens obtained via RP-EBUS-TBLB using a 1.8-mm diameter biopsy forceps allowed analyses of EGFR mutational status, and ALK and PD-L1 IHC, in more than 90% of adenocarcinoma cases. 11 One French study revealed that multigene molecular analyses could be performed on almost 80% of specimens sampled via RP-EBUS-TBLB using a 1.5-mm diameter microbiopsy forceps. 12 We used such forceps, and the statuses of EGFR mutations, ALK, ROS-1, and PD-L1 IHC were evaluable in more than 80% of samples, comparable to a previous study.…”