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

Park, Sojung; Yoon, Hee; Han, Yeji; Wang, Kyung Sook; Park, So Young; Ryu, Yon Ju; Lee, Jin Hwa; Chang, Jung Hyun

doi:10.1111/1759-7714.13446

Cited by 20 publications

(27 citation statements)

References 32 publications

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“…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.…”

Section: Discussionmentioning

confidence: 96%

“…An EBUS image with the probe within the lesion was very closely related to the success of the diagnosis (OR, 28.50) in the bronchus sign negative PPLs, which agrees with most previous studies, including those on bronchus sign positive PPLs. 6 7 12 15 16 …”

Section: Discussionmentioning

confidence: 99%

“…EBUS visualization is very important for diagnostic success in RP-EBUS-TBLB. 6 12 16 This can be predicted by whether a bronchus sign is present on chest CT. Minezawa et al 9 explored the relationship between CT bronchus sign and EBUS findings and found that they correlated strongly with each other. In that study, when the bronchus clearly reached the inside of the target lesion on chest CT, nearly 70% of lesions gave an EBUS image with the probe within the lesion and 20% of lesions gave one with the probe adjacent.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background The presence of the bronchus sign on chest computed tomography is associated with an increased diagnostic yield of radial probe endobronchial ultrasound–guided transbronchial lung biopsy (RP-EBUS-TBLB). However, the utility of RP-EBUS-TBLB for bronchus sign negative peripheral pulmonary lesions (PPLs) remains unknown. We investigated the utility of RP-EBUS-TBLB in bronchus sign negative PPLs. Methods We retrospectively reviewed data from 109 patients who underwent RP-EBUS for bronchus sign negative PPLs from January 2019 to August 2020. TBLB was performed using RP-EBUS with a guide sheath and without fluoroscopy. The EBUS visualization and TBLB diagnostic yields were assessed. Multivariable logistic regression analyses were used to identify factors affecting the EBUS visualization and diagnostic yields. Results The EBUS visualization yield was 74.1% (68/109). Of the 109 lung lesions, 92 were definitively diagnosed. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 50.5% (55/109), 34.9% (29/83), 100% (26/26), 100% (29/29), and 32.5% (26/80), respectively. In multivariable analyses, the size of the lesion (≥ 20 mm; odds ratio [OR], 2.62; 95% confidence interval [CI], 1.16–5.93; P = 0.021) and the distance from the pleura (> 10 mm; OR, 2.37; 95% CI, 1.02–5.52; P = 0.045) were associated with EBUS visualization. Regarding diagnostic yield, having the probe within the lesion (OR, 28.50; 95% CI, 6.26–129.85; P < 0.001) and a solid lesion (OR, 14.58; 95% CI, 2.64–80.38; P = 0.002) were associated with diagnostic success. Pneumothorax and hemoptysis occurred in 3.7% (4/109) and 0.9% (1/109), respectively, of the patients. Conclusion RP-EBUS-TBLB using a GS can be considered a diagnostic method in bronchus sign negative solid PPLs. Having the probe within the lesion and a solid lesion were important for diagnostic success. Complication rates were acceptable.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…We normally use a 1.95‐mm thin GS to introduce instruments when performing repeated conventional biopsies for the diagnosis of PPLs 33 . In the present study, however, a UTB was utilized as a thick GS, with “guided eyes” on the tip of the bronchoscope.…”

Section: Discussionmentioning

confidence: 99%

Ultrathin bronchoscope combined with virtual bronchoscopic navigation and endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions with or without fluoroscopy: A randomized trial

et al. 2021

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Background Transbronchial lung biopsy (TBLB) is usually performed to obtain a definitive diagnosis for peripheral pulmonary lesions (PPLs). Ultrathin bronchoscopy combined with virtual bronchoscopic navigation (VBN) and radial endobronchial ultrasound (R‐EBUS) are generally considered appropriate diagnostic methods for PPLs; however, they have not yet been explored in combination with fluoroscopy. Therefore, the present prospective randomized controlled trial determined the role of fluoroscopy in ultrathin bronchoscopy combined with VBN and R‐EBUS for the diagnosis of PPLs. Methods Patients with potentially malignant PPLs were enrolled in the study and randomized into fluoroscopy or nonfluoroscopy groups. In both groups, a 3.0‐mm outer and 1.7‐mm internal diameter ultrathin bronchoscope was used for transbronchial lung biopsy combined with R‐EBUS and VBN. In addition, the fluoroscopy group (FG) underwent fluoroscopy, while the nonfluoroscopy group (NFG) did not. Results A total of 126 patients were enrolled and randomized in the study. Among them, 120 patients (60 in the NFG and 60 in the FG) were analyzed. The mean lesion sizes were 26.3 ± 11.4 mm and 29.0 ± 11.3 mm in the NFG and FG, respectively. The diagnostic yield was 73.3% (44/60) in the NFG and 81.7% (49/60) in the FG without statistically significant difference (p = 0.38). No obvious complications occurred in either group. Conclusions Ultrathin bronchoscope combined with VBN and R‐EBUS without fluoroscopy is a feasible and safe diagnostic method for PPLs.

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“…Therefore, it is important to develop strategies to determine if a small nodule is malignant when first identified. However, the traditional imaging test, such as CT and R-EBUS, cannot provide sufficient information to detect malignant lesions accurately [42][43][44]. For example, the CT images of 5 cases of patients in this study showed ground glass nodules (GGO).…”

Section: Discussionmentioning

confidence: 76%

Optical coherence tomography for identification of malignant pulmonary nodules based on random forest machine learning algorithm

et al. 2021

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Objective To explore the feasibility of using random forest (RF) machine learning algorithm in assessing normal and malignant peripheral pulmonary nodules based on in vivo endobronchial optical coherence tomography (EB-OCT). Methods A total of 31 patients with pulmonary nodules were admitted to Department of Respiratory Medicine, Zhongda Hospital, Southeast University, and underwent chest CT, EB-OCT and biopsy. Attenuation coefficient and up to 56 different image features were extracted from A-line and B-scan of 1703 EB-OCT images. Attenuation coefficient and 29 image features with significant p-values were used to analyze the differences between normal and malignant samples. A RF classifier was trained using 70% images as training set, while 30% images were included in the testing set. The accuracy of the automated classification was validated by clinically proven pathological results. Results Attenuation coefficient and 29 image features were found to present different properties with significant p-values between normal and malignant EB-OCT images. The RF algorithm successfully classified the malignant pulmonary nodules with sensitivity, specificity, and accuracy of 90.41%, 77.87% and 83.51% respectively. Conclusion It is clinically practical to distinguish the nature of pulmonary nodules by integrating EB-OCT imaging with automated machine learning algorithm. Diagnosis of malignant pulmonary nodules by analyzing quantitative features from EB-OCT images could be a potentially powerful way for early detection of lung cancer.

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

Cited by 20 publications

References 32 publications

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

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

Ultrathin bronchoscope combined with virtual bronchoscopic navigation and endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions with or without fluoroscopy: A randomized trial

Optical coherence tomography for identification of malignant pulmonary nodules based on random forest machine learning algorithm

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