Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Fluoroscopically Invisible Solitary Pulmonary Nodules

Herth, Felix J.F.; Eberhardt, Ralf; Becker, Heinrich D.; Ernst, Armin

doi:10.1378/chest.129.1.147

Cited by 207 publications

(177 citation statements)

References 13 publications

(9 reference statements)

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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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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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“…However, both fluoroscopy and EBUS have been reported to be reliable diagnostic methods for lesions smaller than 3 cm [23]. Herth et al [24] reported that EBUS detected 48 of 54 lesions smaller than 3 cm that could not be detected using fluoroscopy, and that 38 diagnoses were made resulting in a 70% diagnostic rate. Ensminger and Prakash [25] reported a 55% diagnostic rate for 107 biopsies obtained using fluoroscopy on patients with diffuse pulmonary disease, but no endobronchial lesions.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Bronchoscopy with C-Arm Scopy in Cases without Endobronchial Lesion

Emre¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Periferik akciğer lezyonlarında fiberoptik bronkoskopi (FOB) sırasın-da doku ya da sitoloji örneği elde etmek amacıyla C kollu skopi, tüm dünya-da yaygın kullanım alanı bulmuştur. Gereç ve Yöntem: Prospektif olarak planlanan bu gözlem çalışmasında radyolojik olarak kitle lezyonu veya parankimal infiltrasyonu olan, ancak endobronşial lezyon saptanmayan olgularda C kollu skopi eşliğinde bronkoskopik biyopsi, fırçalama ve lavaj örnekleri alınarak tanısal değerleri karşılaştırıldı. Bulgular: Çalışmaya alınan 60 (E=45/K=15) hastanın yaş ortalaması 61.5±9.6 idi. Lezyonlar en sık sağ üst lobda saptandı. Hastaların 45'inde radyolojik olarak periferik kitle, 17'sinde nodül izlenirken; 18'inde konsolidasyon veya infiltrasyon saptandı. Biyopsi ile elde edilen tanı oranı %36 iken, fırçalamada %20, bronkoskopik lavajda %21 olarak değer-lendirildi. Tüm yöntemlerle toplam tanı oranı %45 idi. Tümör çapına göre tanı oranı karşılaştırıldığında 3 cm'den büyük lezyonlarda %48.1 ve 3 cm'den küçük lezyonlarda %31.8 saptandı. 3 cm'den küçük lezyonlarda fırçalamanın istatistiksel olarak anlamlı bir şekilde etkisiz olduğu görüldü. Regresyon analizinde tanıya katkısı olan bağımsız faktör bulunmadı. İşlem sırasında hiçbir hastada ciddi bir komplikasyon gözlenmedi. Tartışma: Çalışmamızda C kollu skopi eşliğinde yapılan bronkoskopinin periferik lezyonların tanı etkinliğini arttıran güvenli bir yöntem olduğunu gözledik. Biyopsinin diğer yöntemlere göre daha etkili olduğu, ancak tanı duyarlılığını arttırmak için diğer yöntemlerle kombine edilmesi gerektiği, fırçalamanın 3 cm'den küçük lezyonlarda tanıya katkısı-nın olmadığı sonucuna vardık. Anahtar KelimelerBronchoscopy; C-Arm Scopy; Diagnosis; Peripheral Pulmonary Lesion; Tumor Abstract Aim: Fiberoptic bronchoscopy (FOB) is widely used in the diagnosis and treatment of pulmonary diseases. FOB sensitivity is generally low in tumors localized in the outer third of the lung. Diagnosis of peripheral pulmonary lesions can be difficult; however, the use of computed tomography (CT)-, fluoroscopy-or ultrasonography (USG)-guided surgery increases the diagnostic rates. In this study we aimed to compare the diagnostic values of C-arm fluoroscopy-guided bronchoscopic lavage, brushing, and biopsy samples obtained in cases where radiological masses or parenchymal lesions were detected, but endobronchial pathology was not found. Material and Method: In this prospective observational study, bronchoscopy was performed to the patients who had a mass lesion or parenchymal infiltration on chest radiogram and who had no endobronchial lesion, the diagnostic results of the bronchoscopic lavage, brush and biopsy specimens have been compared where C-arm scopy guided the procedures. Results: 60 patients (45 male) with a mean age 61.5±9.6 were enrolled into the study. The lesions were mostly located in the right upper lobe. 45 patients had peripheral mass lesion, 17 patients had noduler lesion where consolidation or infiltration were present in 18 patients. The diagnostic yield of the bronchoscopic biopsy wa...

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“…A few studies have evaluated the role of EBUS to guide sampling from the periphery of the lung (Level of evidence: III) [6,[31][32][33]. EBUS is superior to "blind" transbronchial biopsy (that is, transbronchial biopsy performed without any imaging guidance) in the diagnosis of peripheral lung lesions [31].…”

Section: Ebus For Guiding Biopsy Of Peripheral Lesionsmentioning

confidence: 99%

Autofluorescence Bronchoscopy and Endobronchial Ultrasound

Falcone

Majori

Grosso

et al. 2015

Monaldi Arch Chest Dis

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Autofluorescence and ultrasound represent the imaging technologies applied to diagnostic bronchoscopy that have found the largest resonance in recent decades [1,2]. Autofluorescence bronchoscopy (AFB) has gained an established role in the diagnosis of preneoplastic lesions or intraepithelial lung cancer [1][2][3][4]. Endobronchial ultrasound (EBUS) has been used for multiple purposes, such as [1,[5][6][7]: 1) facilitating identification and aspiration from hilar and mediastinal lesions in close contact with the airway's wall; 2) guiding transbronchial biopsies in patients with peripheral lesions; 3) differentiating airway invasion versus compression, as well as helping to determine the depth of invasion in patients with central airway tumours. Autofluorescence bronchoscopyThe outcome of patients diagnosed with lung cancer is fairly poor, and the chances of survival are largely dependent on the stage of the disease allowing for curative surgery [8]. AFB is a screening measure that has been developed in an attempt to identify high-risk patients harbouring pre-neoplastic and early neoplastic lesions in their central airways [9]. The use of AFB is based on the observation that moderate to severe dysplasia and carcinoma in situ (CIS) show less fluorescence than normal tissue when excited by light with wave length ranging from 380-460 nm.In the multicentric study leading to FDA approval, Lam et al. investigated the additional role of AFB, when added to white light bronchoscopy (WLB), in the identification of moderate/severe dysplasia and CIS in 173 patients with known or suspected lung cancer (Level of evidence: III) [3]. The investigators found that AFB + WLB had a relative sensitivity of 6.3 compared to WLB alone. The specificity of AFB was 66%.Many subsequent literature studies (Level of evidence: III) including varying categories of patients with known/suspected lung cancer, or at high-risk of developing lung cancer, confirmed the superiority of AFB + WLB versus WLB in the detection of dysplasia and CIS, even though the relative sensitivity of AFL + WLB was usually found to be lower than that reported in the 1998 study by Lam et coll [10][11][12][13].More recently, the first prospective, randomised, multicentric study compared WLB + AFB versus WLB in 1173 smokers with additional risk factors for lung cancer (Level of evidence: Ib) [4]. The results of this study confirmed the superiority of AFB over WLB in the detection of preneoplastic and early neoplastic lesions, but did not support the high expectations raised by many previous studies. First, the prevalence of isolated pre-invasive lesions was much lower (3.9%) than in most former studies, probably due to the fact that the latter ones often included tumour associated lesions. Second, the relative sensitivity of WLB + AFB versus WLB alone found in this study (1.42) was much lower than in many previous studies, and the superiority of AFB over WLB was statistically significant only for moderate/severe dysplasia and not for CIS. The specificity was 58% for WLB + AF...

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Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Fluoroscopically Invisible Solitary Pulmonary Nodules

Cited by 207 publications

References 13 publications

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

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

Diagnostic Yield of Bronchoscopy with C-Arm Scopy in Cases without Endobronchial Lesion

Autofluorescence Bronchoscopy and Endobronchial Ultrasound

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