Endobronchial ultrasonography with distance for peripheral pulmonary lesions

Chung, Yoon Kyu; Lie, Chien‐Hao; Chao, Tung‐Ying; Wang, Yi‐Hsi; Lin, An‐Shen; Wang, Jui-Long; Lin, Meng-Chih

doi:10.1016/j.rmed.2006.08.014

Cited by 40 publications

(46 citation statements)

References 14 publications

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“…This may be illustrated by the observation that nonbronchogenic lesions (e.g. metastases, benign lesions), which are more likely to be parenchymally based than endoluminal, have a significantly lower yield for EBUS-directed sampling [7,15,19]. It is worth noting, as we have in this cohort, that even following localisation of NSCLC lesions with probe position within the target, a minority of procedures remain nondiagnostic [15,22,23].…”

Section: Discussionmentioning

confidence: 87%

“…Given probe position adjacent to the lesion is associated with reduced yield of EBUS [15][16][17][18][19], we reasoned that EMN may provide improved diagnostic outcomes in this scenario. In contrast, probe localisation within the target PPL is associated with a high sensitivity and therefore EMN would not further improve localisation or diagnostic performance for such lesions.…”

Section: Performance Of Bronchoscopymentioning

confidence: 99%

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Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±SD). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield. @ERSpublications EMN after nondiagnostic radial EBUS gives only small incremental gain in visualisation rate and diagnostic yield

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Section: Discussionmentioning

confidence: 87%

Section: Performance Of Bronchoscopymentioning

confidence: 99%

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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“…The following studies reported that the diagnostic yield of EBUS-GS for PPLs was between 57% and 90%, and it was proved to be a safe procedure with low rate of pneumothorax and hemoptysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Till now there is only one randomized controlled study (22) comparing the two procedures.…”

Section: Introductionmentioning

confidence: 99%

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

et al. 2016

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Background: Computed tomography guided transthoracic needle aspiration (CT-TTNA) and endobronchial ultrasonography with guide sheath (EBUS-GS) transbronchial lung biopsy are important methods for the diagnosis of peripheral pulmonary lesions (PPLs). Without enough evidence, it is controversial which is a better choice for diagnosing PPLs. In this study, we hypothesized that the complication rate of EBUS-GS would be lower than CT-TTNA and the diagnostic accuracy of EBUS-GS were not inferior to CT-TTNA. Methods: This study was a retrospective analysis of a prospective registry with propensity matching.Patients with PPLs were divided into EBUS-GS group and CT-TTNA group according to patients' intent to treatment. Pathological results and procedure related complications of EBUS-GS and CT-TTNA were recorded. Propensity score matching(PSM) was used to eliminate the intergroup bias. Diagnostic yields and complications of two groups were compared. Subgroup analysis was performed to conclude the indications of different procedures. Results: A total of 187 patients (CT-TTNA: 130; EBUS-GS: 57) were enrolled. After propensity score matching, 54 paired patients were included. Diagnostic yield was 81% (44/54) for EBUS-GS and 87% (47/54) for CT-TTNA (P=0.43), respectively. Diagnostic sensitivity in malignancy was 93% (42/45) for CT-TTNA and 79% (37/47) for EUBS-GS (P=0.04). Subgroup analysis revealed that the sensitivity of CT-TTNA was significantly higher in diagnosing of lesions close to the chest wall (100% vs. 80%, P=0.04), and bronchus sign on CT was a predictive factor for accurate diagnosis by EBUS-GS. The overall complication rate was 13% (7/54) for CT-TTNA group, which was not significantly higher than that of EBUS-GS group (2%, P=0.06). Subgroup analysis showed that patients combined with pulmonary comorbidities and lesions apart from chest wall were risk factors for complications of CT-TTNA. Conclusions: Both of the two procedures are effective for the diagnosis of PPLs, but CT-TTNA has a higher diagnostic sensitivity for malignancy. EBUS-GS has fewer complications, and it is more suitable for patients combined with pulmonary comorbidities and lesions with bronchus signs.

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“…The diagnostic efficiency of this method has been previously reported (9,11). However, the present study used postoperative pathology as the gold standard for the diagnosis of lung cancer, which allows the study results to be confirmed more objectively and accurately.…”

Section: Introductionmentioning

confidence: 91%

“…In addition, a GS is expensive as a disposable supply. An alternative method is TBB guided by EBUS with distance measurement (EBUS-D) (9). Many studies have confirmed the effectiveness and safety of this method (8,(10)(11)(12)(13), and it has been shown that the use of this technique in fine bronchoscopy can further increase the diagnostic rate (53% vs. 73%) (10,11).…”

Section: Introductionmentioning

confidence: 99%

Radial endobronchial ultrasonography with distance measurement through a thin bronchoscope for the diagnosis of malignant peripheral pulmonary lesions

Zhang

Zhou

et al. 2018

Transl. Lung Cancer Res.

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Background: Peripheral pulmonary lesions (PPLs) are being discovered more frequently. We investigated efficiency, safety, and influencing factors in radial probe endobronchial ultrasound with distance measurement (rEBUS-D) using a thin bronchoscope during transbronchial biopsy (TBB) for the diagnosis of malignant PPLs. Methods:Patients with PPLs who underwent rEBUS were retrospectively analyzed. Cases with rEBUS-D and a gold-standard final diagnosis were considered.Results: rEBUS was completed in 589 cases; 328 were analyzed. The lesion discovery rate was 85.06%; the overall rEBUS-D-TBB diagnostic rate was 54.88%. There were 193 cases of malignant tumors. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of rEBUS-D-TBB in the diagnosis of malignant PPLs were 63.73%, 100%, 100%, 65.85%, and 78.40%, respectively.Single-and multi-factor analyses showed that lesion size, ultrasound probe position, and a positive bronchus sign on thoracic computed tomography (CT) were significant factors influencing diagnosis (all P=0.000); probe position and the bronchus sign were independent influencing factors. The effect of lesion distribution on diagnosis was not significant. In seven cases, postoperative pathology showed mixed tumors. Two cases of malignant tumors were combined with benign pathology; rEBUS-D-TBB did not suggest two pathologies. Thirteen cases had 50-100 mL of blood loss (3.96%); no pneumothorax or infection was observed.Conclusions: rEBUS-D-TBB had high sensitivity, 100% specificity, excellent safety, and a lower cost than rEBUS-GS-TBB in the diagnosis of malignant PPLs. Larger lesions, a positive bronchus sign on CT, and ultrasound probe position at the lesion's center yielded higher diagnostic rates.

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Endobronchial ultrasonography with distance for peripheral pulmonary lesions

Abstract: Measuring and applying the distance between the orifice of bronchus and the lesion could increase the diagnostic yield of EBUS-guided TBBs for PPLs.

Cited by 40 publications

References 14 publications

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

Radial endobronchial ultrasonography with distance measurement through a thin bronchoscope for the diagnosis of malignant peripheral pulmonary lesions

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