Diagnostic value of radial endobronchial ultrasonographic features in predominant solid peripheral pulmonary lesions

Abstract

Background: Transbronchial lung biopsy (TBLB) of peripheral pulmonary lesions (PPLs) is usually performed for a definite diagnosis. Radial probe endobronchial ultrasonography is often acknowledged as a good guidance method for TBLB as it can help physicians confirm the lesions' position. It is also a non-invasive imaging diagnostic method. This clinical study was designed to evaluate the ability of radial endobronchial ultrasonography (R-EBUS) to differentiate benign from malignant predominant solid PPLs based on imaging features. Methods: Patients with predominant solid PPLs were enrolled in this study retrospectively. TBLB was performed using R-EBUS with or without other guidance techniques. One typical sonographic image and one video of each lesion were recorded for analysis. Six radial probe endobronchial ultrasonographic image features (size, shape, echogenicity, margin, blood vessel, and linear-discrete air bronchogram) were studied by ultrasonography specialists and physicians who were blinded to the final diagnosis. The sum score model of the combined predictive factors indicated the best diagnostic accuracies for predicting malignant PPLs. The model group results were used to establish the diagnostic standard for a verification group.Results: A total of 303 patients were enrolled in the model group from July 2018 to July 2019 at the Shanghai Chest Hospital (214 with malignant and 89 with benign lesions). The mean lesion long axis on computed tomographic images was 34.39±13.79 mm. There were significant statistical differences between benign and malignant lesions in the long axis, short axis, shape, margin, blood vessel, and linear-discrete air bronchogram assessed by radial endobronchial ultrasound. Long axis, lobulation, distinct but not sharp margin, absence of blood vessel, and absence of linear-discrete air bronchogram were good predictive factors of malignant lesions. A sum score model value of 79.54% of these combined factors indicated the best diagnostic accuracy for predicting malignant lesions. Eighty-seven patients were enrolled in the verification group from August to October 2019. The sum score model showed a diagnostic accuracy of 82.76%. Conclusions: Radial endobronchial ultrasonographic features can differentiate malignant from benign lesions and thus have potential diagnosis value in predominant solid PPLs.

Using cryobiopsy with Radial EBUS in high‐bleeding‐risk, peripheral pulmonary lesions (PPL): description of cases and technique

“…The radial EBUS ultrasound can be used to examine the PPL characteristics of size, shape, echogenicity, margin and blood vessels. 12 Despite lacking the ability to obtain a Doppler flow, the demonstration of hypoechoic areas, and noting pulsations within the PPL in keeping with vascularity is providing valuable information. Using Radial EBUS to guide the location of TBCB in ILD had been proposed as a method to reduce the bleeding risk with TBCB in ILD.…”

Nondiagnostic, radial‐probe endobronchial ultrasound‐guided biopsy for peripheral lung lesions: The added value of radiomics from ultrasound imaging for predicting malignancy

“…To diagnose the indeterminate cases, several attempts have been made to extract additional information from radial EBUS images. Zheng et al 22 built a predictive model with semantic features from radial EBUS images (size, shape, echogenicity, margin, blood vessel, and linear‐discrete air bronchogram), and achieved an accuracy of 82.76%. Bradiei et al 23 analyzed radial EBUS images using customized software and computed grayscale statistics (maximum, mean, standard deviation, and entropy) to predict malignancy and achieved accuracy up to 85%.…”

Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

“…The implementation of care bundles have been shown to have significant institutional barriers, which may not be overcome by traditional plan-do-study-act quality improvement cycles 39 , 40 . Importantly, neither the ‘Sepsis Six’ bundle, nor the SEP-1 bundle has been tested in a robust randomised controlled trial (RCT) and their perceived effectiveness has been derived from observational before and after studies with high risk of bias 41 . We believe, based on the individual bundle element compliance figures, that our data may show the presence of clinical equipoise for an RCT to test whether a bundle approach indeed improves outcomes compared to the current apparent standard care of administering supplemental oxygen and antibiotics to the majority of the patients with NEWS above 6.…”