Endobronchial ultrasound plus fluoroscopy-guided biopsy compared to fluoroscopy-guided transbronchial biopsy for obtaining samples of peripheral pulmonary lesions: A systematic review and meta-analysis

Ye, Jian; Zhang, Ruifeng; Ma, Shenglin; Wang, Limin; Jin, Wu

doi:10.4103/atm.atm_298_16

Cited by 7 publications

(2 citation statements)

References 31 publications

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“…Finally, auxiliary bronchoscopic procedures, such as fluoroscopy or a guide sheath, were not conducted on our study subjects. Since adding these modalities to rEBUS-guided TBB may help achieve a rather favorable diagnostic yield in PPLs, [ 17 , 18 ] it is uncertain whether our findings remain valid when ancillary tools are coupled to rEBUS-guided procedures.…”

Section: Discussionmentioning

confidence: 99%

The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions

Huang

Tsai

et al. 2017

BMC Pulm Med

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BackgroundRadial-probe endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) is invaluable in the diagnosis of peripheral pulmonary lesions (PPLs); however, in certain instances, the procedure has to be repeated because of initial non-diagnostic procedure(s). Little if any literature has been published on this issue. Therefore, the aim of this study was to investigate the utility of repeat rEBUS-guided TBB in achieving a definitive diagnosis of PPLs.MethodsAll patients who underwent rEBUS-guided TBB of PPLs at National Taiwan University Hospital between 2011 and 2015 and had a repeat procedure after non-diagnostic initial procedures were identified as the study subjects. The primary outcome of interest was the diagnostic yield of repeat rEBUS-guided TBB for PPLs. Also, we sought to discover features associated with the yield of repeat procedures.ResultsForty-three (11%) out of 384 patients with initial non-diagnostic TBB were included for analysis. A diagnosis of PPLs was able to be confirmed with repeat TBB in 23(53%) patients. The pathology of the first TBB was significantly associated with the yield of repeat procedures (P = 0.011). Further, patients with normal lung tissue in initial pathology rarely (2/12, 17%) had a definite diagnosis on repeat TBB. Yet, patients with pathology showing atypical cells and other non-specific findings were more likely (21/31, 68%) to obtain a confirmed diagnosis. The diagnostic yield of repeat procedures was not affected by the size, location or CT appearance of the lesions, or position of the rEBUS probe. No death or other serious adverse events occurred with the repeat rEBUS-guided procedures.ConclusionsIf clinically indicated, it is reasonable to repeat rEBUS-guided TBB after an initial non-diagnostic procedure as the diagnostic yield will be at least 50% and the side effect profile is favorable.

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Section: Discussionmentioning

confidence: 99%

The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions

Huang

Tsai

et al. 2017

BMC Pulm Med

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“…H erth et al . [ 5 ] first described the use of EBUS to guide transbronchial biopsy (TBB) of PPLs in 2002, and numerous studies since then have shown a superior diagnostic yield of PPLs using TBB under EBUS guidance, as compared to conventional bronchoscopy [ 6 – 9 ]. A notable methodological limitation inherent to EBUS is that it does not provide real-time images for TBB procedures; thus, the biopsy forceps may not always be advanced into the target bronchus from which the EBUS image has been obtained.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Bronchoscopic diagnosis of peripheral lung lesions

Gasparini

Mei²,

Bonifazi

et al. 2021

Current Opinion in Pulmonary Medicine

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Purpose of reviewOver the last decades, in addition to the traditional fluoroscopy, various and innovative guidance systems have been adopted in clinical practice for transbronchial approach to peripheral pulmonary lesions (PPLs). The aim of this article is to summarize the most recent data on available guidance systems and sampling tools, evaluating also advantages and limitations of each technique. Recent findingsAlthough several studies have been published over the last years, large randomized studies comparing the different techniques are scanty. Fluoroscopy is the traditional and still most widely utilized guidance system. New guidance systems (electromagnetic navigation bronchoscopy, ultrasound miniprobe, cone beam computed tomography) seems to provide a better sensitivity, especially for small lesions not visualized by fluoroscopy. Among the sampling instruments, there is a good evidence that flexible transbronchial needle provides the better diagnostic yield and that sensitivity may increase if more than one sampling instrument is used. SummaryEven if great progress has been done since the first articles on the transbronchial approach to PPLs, better scientific evidence and more reliable randomized trials are needed to guide interventional pulmonologists in choosing the best technique according to different clinical scenarios and source availability.

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Endobronchial ultrasound plus fluoroscopy-guided biopsy compared to fluoroscopy-guided transbronchial biopsy for obtaining samples of peripheral pulmonary lesions: A systematic review and meta-analysis

Cited by 7 publications

References 31 publications

The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions

The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions

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

Bronchoscopic diagnosis of peripheral lung lesions

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