The Value of Combined Radial Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy and Metagenomic Next-Generation Sequencing for Peripheral Pulmonary Infectious Lesions

Abstract

Background. Metagenomic next-generation sequencing (mNGS) is a new technology that allows for unbiased detection of pathogens. However, there are few reports on mNGS of lung biopsy tissues for pulmonary infection diagnosis. In addition, radial endobronchial ultrasound (R-EBUS) is widely used to detect peripheral pulmonary lesions (PPLs), but it is rarely used in the diagnosis of peripheral lung infection. Objective. The present study aims to evaluate the combined application of R-EBUS-guided transbronchial lung biopsy (TBLB) and mNGS for the diagnosis of peripheral pulmonary infectious lesions. Methods. From July 2018 to April 2019, 121 patients from Tianjin Medical University General Hospital diagnosed with PPLs and lung infection were enrolled in this prospective randomized study . Once the lesion was located, either TBLB or R-EBUS-guided-TBLB was performed in randomly selected patients, and mNGS was applied for pathogen detection in lung biopsy tissues. The results of mNGS were compared between the TBLB group and R-EBUS-guided TBLB group. In addition, the clinical characteristics and EBUS images from 61 patients receiving bronchoscopy for peripheral lung infectious detection were analyzed and compared with the results of mNGS. Results. The positivity rate of mNGS in R-EBUS-guided TBLB was (78.7%, 48/61) that was significantly higher than (60.0%, 36/60) in the TBLB group. Difference in the position of R-EBUS probe and image characteristics of peripheral lung infectious lesions affected the positivity rate of mNGS. Tissue collected by R-EBUS within the lesion produced higher positivity rate than samples collected adjacent to the lesion (P=0.030, odds ratio 17.742; 95% confidence interval, from 1.325 to 237.645). Anechoic areas and luminant areas of ultrasonic image characteristics were correlated with lower positivity rate of mNGS (respectively, P=0.019, odds ratio 17.878; 95% confidence interval, from 1.595 to 200.399; P=0.042, odds ratio 16.745; 95% confidence interval, from 1.106 to 253.479). Conclusions. R-EBUS-guided TBLB is a safe and effective technique in the diagnosis of peripheral lung infectious lesions. R-EBUS significantly facilitates the accurate insertion of bronchoscope into the lesions, which improves positivity rate of mNGS analysis in pathogen detection. The R-EBUS probe position within lesion produced a higher positivity rate of mNGS analysis. Nevertheless, the presence of anechoic and luminant areas on ultrasonic image was correlated with poor mNGS positivity rate.

Clinical Characteristics of Chronic Lung Abscess Associated with Parvimonas micra Diagnosed Using Metagenomic Next-Generation Sequencing

“…By analyzing the content and abundance of DNA or the RNA of microorganisms in clinical samples, this technology could be used to determine the pathogenic bacteria and was successfully applied to identify the pathogens from patients' BALF or lung tissue samples. [25][26][27][28] Importantly, the sensitivity of using mNGS to diagnose infectious diseases was higher than conventional culture, especially for bacteria that are difficult to cultivate, such as anaerobes. 29,30 Moreover, mNGS is less affected by antibiotic exposure before sample detection, 29 and thus has more advantages in detecting the co-infection of multiple bacteria.…”

The Diagnostic Value of Metagenomic Next–Generation Sequencing in Lower Respiratory Tract Infection

“…On the other hand, the TBLB mNGS provides more accurate diagnostic results, while the hard-to-obtain specimens should be diagnosed using BALF sampling methods. A study showed that the positive rate of TBLB mNGS guided by R-EBUS (78.7%) was significantly higher than that of the TBLB group (60.0%), because R-EBUS significantly improved the accuracy of bronchoscopy in obtaining lesion specimens ( Li et al., 2020 ). ROSE is a rapid cytological evaluation technology that can be used for tissue sample collection ( Ganc et al., 2015 ).…”

Comparison of endotracheal aspirate and bronchoalveolar lavage fluid metagenomic next-generation sequencing in severe pneumonia: a nested, matched case-control study

“…The establishment of localized experimental platforms can even provide valid etiological information within 10-24 hours. In addition, as an unbiased detection method, mNGS can simultaneously detect a diverse range of microorganisms, including bacteria, fungi, and viruses, in clinical specimens [4].…”