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

Abstract

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.

Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

“…Moreover, Zhang et al's study22 suggested the diagnostic yield with R-EBUS with distance-measurement is not inferior to the yield with R-EBUS with GS. In studies with R-EBUS procedure with distance-measurement method, the reported diagnostic accuracy was 77%–87%111223 and we achieved an 80% diagnostic yield. Although R-EBUS-guided TBLB showed comparable accuracy to transthoracic needle biopsy24, the relatively high rate of false-negatives resulted in low negative predictive values (44%–46%), including in our study25.…”

Diagnostic yield of radial probe endobronchial ultrasonography‐guided transbronchial biopsy without fluoroscopy in peripheral pulmonary lesions: A systematic review and meta‐analysis

“…Subsequently, 71 articles were selected for full text review. Forty records were excluded for the reasons presented in Figure 1, and 31 articles that met the defined inclusion criteria were finally included 5,14–43 …”

“…Forty records were excluded for the reasons presented in Figure 1 , and 31 articles that met the defined inclusion criteria were finally included. 5 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 …”

Utility of Radial Endobronchial Ultrasound with a Guide Sheath for Peripheral Pulmonary Lesions in Patients with Pulmonary Emphysema: A Retrospective Study

“…In particular, the EBUS-GS-TBB complication rate may have been underestimated in this study. Third, all EBUS-GS-TBB procedures were performed without the assistance of a navigation system, such as ENB, X-ray uoroscopy, or VB [35,36].…”