Safety and Diagnostic Yield of Radial Probe Endobronchial Ultrasound-Guided Biopsy for Peripheral Lung Lesions in Patients with Idiopathic Pulmonary Fibrosis: A Multicenter Cross-Sectional Study

Abstract

<b><i>Background:</i></b> Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used for diagnosis of peripheral lung lesions (PLLs). To date, there have been no reports regarding the clinical outcomes of RP-EBUS-TBLB for PLLs in patients with idiopathic pulmonary fibrosis (IPF). <b><i>Objectives:</i></b> This study was performed between October 2017 and December 2019 to identify the safety and diagnostic performance of RP-EBUS-TBLB in IPF patients. <b><i>Methods:</i></b> Patients were divided into the usual interstitial pneumonia (UIP) group (<i>n</i> = 39, 4%), the probable UIP group (<i>n</i> = 12, 1%), and the noninterstitial lung disease (non-ILD) group (<i>n</i> = 903, 95%). <b><i>Results:</i></b> The diagnostic yield was significantly lower in the UIP group than in the non-ILD group (62% vs. 76%; <i>p</i> = 0.042), but there were no significant differences between the UIP and probable UIP groups (62% vs. 83%; <i>p</i> = 0.293) or the probable UIP and non-ILD groups (83% vs. 76%; <i>p</i> = 0.741). Multivariate logistic analysis showed that the mean diameter of PLLs, positive bronchus sign on CT, and “within the lesion” status on EBUS were independently associated with success of the procedure. Especially, the presence of the UIP pattern on CT (OR, 0.385; 95% CI: 0.172–0.863; <i>p</i> = 0.020) was independently associated with failed diagnosis. Among patients with UIP, “within the lesion” status on EBUS (OR, 25.432; 95% CI: 2.321–278.666; <i>p</i> = 0.008) was shown to be a factor contributing to a successful diagnosis. Overall, there were no significant differences in complication rates among the 3 study groups. <b><i>Conclusion:</i></b> RP-EBUS-TBLB can be performed safely with an acceptable diagnostic yield, even in patients with IPF.

A Diagnostic Predictive Model of Bronchoscopy with Radial Endobronchial Ultrasound for Peripheral Pulmonary Lesions

“…Significant factors that have been previously reported to affect the diagnostic yield of bronchoscopy include factors such as the bronchus sign, lesion size, lesion location from the hilum, and presence of pulmonary emphysema and usual interstitial pneumonia in the background lung [10, 11, 18, 26]. The bronchus sign is well known to be one of the most influential factors on the diagnostic yield of bronchoscopy for PPLs [10], and it also had the largest OR in the multivariable analysis of this study (3.82; 95% CI = 2.84–5.14).…”

“…Although the diagnostic yield varied depending on the severity of emphysema, the presence of emphysema itself has not been reported to reduce the yield [18], and our results are consistent with the previous study in this regard. Furthermore, the presence of usual interstitial pneumonia has been reported to contribute to diagnostic failure [26]. Lung cancer is known to be most likely to appear in the lower lobe, peripheral lung, and around the honeycomb formation in patients with ILAs [29].…”

The Additive Impact of Transbronchial Cryobiopsy Using a 1.1-mm Diameter Cryoprobe on Conventional Biopsy for Peripheral Lung Nodules

“…In the multivariate analysis, PLLs with the longest diameter of ≤ 22 mm were identified as an independent factor with an additional diagnostic benefit from cryobiopsy. Previous studies have shown that the size of the PLL is significantly related to the diagnostic yield of bronchoscopy [19][20][21][22]; that is, the smaller the size, the lower the diagnosis rate. Our data suggest that sequential TBC is a reasonable method to increase the diagnostic yield of small PLL, especially those ≤ 22 mm.…”

Lungenfibrose: Diagnostik peripherer Lungenläsionen nicht verzögern

“…In der hier kommentierten, retrospektiven, multizentrischen Studie aus Korea [ 2 ] wurden insgesamt 954 Patienten eingeschlossen, die in Computertomographien (CT) auffällige PLLs zeigten. Bei 39 dieser Patienten fand sich radiologisch ein UIP (usual interstitial pneumonia, gewöhnliche interstitielle Pneumonie)-Muster (nach der internationalen Empfehlung) [ 3 ], bei 12 ein wahrscheinliches UIP (probable-UIP)-Muster, bei 903 konnte kein Hinweis auf eine interstitielle Lungenerkrankung (noninterstitial lung disease, non-ILD) gefunden werden.…”