Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for peripheral pulmonary malignancy

Abstract

Endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) is a common procedure used to diagnose peripheral pulmonary lesions (PPLs). However, existing literature did not conclusively show a difference in the ability of EBUS-TBB with and without a guide-sheath (GS) to diagnose PPLs. This multicenter cohort study enrolled patients presenting for EBUS-TBB of PPLs that finally proved to be malignant. The diagnostic yield and complication rate were compared between patients undergoing EBUS-TBB with and without a GS (EBUS-TBB+GS versus EBUS-TBB-GS). A propensity score matching method was used to balance differences of pertinent clinical features between the two groups. The original cohort consisted of 975 patients (556 in EBUS-TBB-GS; 419 in EBUS-TBB+GS). GS guidance was more likely to be used with smaller (40 mm versus 44 mm) and middle or lower lobe (60% versus 35%) lesions. After propensity score matching, 720 (360 in each group) patients were included; the diagnostic yields for PPLs were 79% and 78% for EBUS-TBB-GS and EBUS-TBB+GS groups, respectively (p=0.649). The complication rates (5.8% versus 7.2% for bleeding; 0.6% versus 1.9% for pneumothorax) appeared to be lower in the EBUS-TBB+GS group, but the differences did not reach statistical significance. The procedure time was significantly longer in the EBUS-TBB+GS group than in the EBUS-TBB-GS group (29 min versus 24 min; p<0.001). In conclusion, adding a GS to EBUS-TBB did not improve the diagnostic yield for malignant PPLs. GS guidance was seemingly associated with a lower number of complications after TBB but contributed significantly to a longer procedure time.

Assessment of using radial probe endobronchial ultrasound with a guide sheath to increase the yield rate of transbronchial biopsy: A prospective randomized trial

“…(25) Our study con rmed this result, with the nding that there was much less moderate bleeding (grade 2 and above) in the GS group (GS vs. conventional: 9.3% vs. 20.8%, p = 0.049). Procedure time results were inconsistent in different studies, with some suggesting that procedure time was longer in the GS group, (33,34) while others indicated it was shorter than with the conventional procedure. (27) In our study, the procedure time was longer in the GS group (GS vs. conventional: 17.6 ± 4.7 min vs. 15.1 ± 4.5 min, p = 0.008).…”

Inheritance and innovation of the diagnosis of peripheral pulmonary lesions

“…After locating the lesion, withdraw the probe with GS left in situ to ensure the biopsy from the right position. Nevertheless, Kramer and Annema, 70 Ho et al, 77 and Huang et al, 78 clarified that the diagnostic yield did not have an obvious improvement after the introduction of GS, which may be related to the movement or dislodgement of the sheath caused by stiff biopsy tools. 79 On the contrary, Oki et al 80 conducted a multicenter randomized trial showing that histological specimens had a higher diagnostic yield in the GS group (55.3% vs 46.6%, p = 0.033), and the diagnostic yield of upper lobe lesions could be significantly improved upon using GS (63.1% vs 42.9%, p = 0.003).…”

Factors related to the diagnosis of lung cancer by transbronchial biopsy with endobronchial ultrasonography and a guide sheath

“… 9 , 10 Ali et al reported that the diagnostic yield of peripheral lesions by radial endobronchial ultrasound was 72.3% in their meta‐analysis of 25 prospective studies with 2920 lesions, 11 even though a recent report from Huang et al from Taiwan did not show the superiority of using EBUS with GS compared to EBUS without GS. 12 …”

“…A guide sheath has the capacity to fix the appropriate bronchus with reduced bleeding as a complication, and radial ultrasonography can detect surrounding tumor directly 7,8 which contributes to an increased diagnosis rate of lung cancer 9,10 . Ali et al reported that the diagnostic yield of peripheral lesions by radial endobronchial ultrasound was 72.3% in their meta‐analysis of 25 prospective studies with 2920 lesions, 11 even though a recent report from Huang et al from Taiwan did not show the superiority of using EBUS with GS compared to EBUS without GS 12 …”

“…9,10 Ali et al reported that the diagnostic yield of peripheral lesions by radial endobronchial ultrasound was 72.3% in their meta-analysis of 25 prospective studies with 2920 lesions, 11 even though a recent report from Huang et al from Taiwan did not show the superiority of using EBUS with GS compared to EBUS without GS. 12 In a Japanese, single-center, retrospective analysis, Minami et al showed that the diagnostic sensitivity for lung cancer in 60 patients who underwent EBUS-GS was higher, at 83.3%, than that for 50 patients who underwent transbronchial biopsy (TBB) without EBUS-GS, at 68%, and they concluded that EBUS-GS is effective for diagnosing lung cancers <20 mm. 13 In addition, the bronchus sign, which is defined as the responsible bronchus clearly reaching inside the target lesion 14 and detection on EBUS imaging, within or adjacent to the lesion, were also identified as factors associated with making the diagnosis of lung cancer by TBB with EBUS-GS.…”