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

Huang, Chun-Ta; Tsai, Yi-Ju; Ho, Chao‐Chi; Yu, Chong‐Jen

doi:10.1186/s12890-017-0478-3

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…The authors concluded that RP‐EBUS is comparable with fluoroscopy for diagnosis of peripheral lung lesions with no associated risk of radiation 11 . From that point, other studies have described RP‐EBUS‐guided TBB as a feasible and effective technique for diagnosis of peripheral lung lesions 12‐14 . In our study with RP‐EBUS‐guided forceps TBB the sensitivity and accuracy were 67.5% and 69.8%, respectively.…”

Section: Discussionsupporting

confidence: 57%

Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions

Torky

El-Shimy

Ragab

et al. 2020

Clinical Respiratory J

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Introduction Radial probe endobronchial ultrasound (RP‐EBUS) is a modern technique for diagnosis of peripheral lung lesions. It is assumed that the addition of transbronchial cryobiopsy (TBCB) could increase the diagnostic value for RP‐EBUS. Objectives The main objectives were to evaluate the efficacy and safety of RP‐EBUS‐guided TBCB for diagnosis of peripheral lung lesions and comparing it with RP‐EBUS‐guided transbronchial forceps biopsy. Methods Sixty patients with peripheral lung diseases were divided into two groups. Group I included 45 patients who were eligible for TBCB and they subjected to forceps transbronchial biopsy (forceps TBB) and TBCB guided by RP‐EBUS. Fifteen patients who were not eligible for TBCB were included in group II and they were subjected to forceps TBB and/or cytology retrieval procedures guided by RP‐EBUS. Results In group I, forceps TBB had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of; 67.5%, 100%, 100%, 18.8%, and 69.8%, respectively, while TBCB had sensitivity, specificity, PPV, NPV, and accuracy of 75%, 100%, 100%, 23.1%, and 76.7%, respectively. The sensitivity in group II was 80% and the overall results including both groups were sensitivity, specificity, PPV, NPV, and accuracy of 85.2%, 100%, 100%, 42.8%, and 86.7%, respectively. Regarding the complications, only one patient (1.7%) had significant bleeding. One patient (1.7%) had pneumothorax and another patient (1.7%) suffered from hypoxemia. Conclusions RP‐EBUS‐guided TBCB is a safe and effective technique for diagnosis of peripheral lung lesions. TBCB has achieved higher diagnostic values and better quality of samples.

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Section: Discussionsupporting

confidence: 57%

Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions

Torky

El-Shimy

Ragab

et al. 2020

Clinical Respiratory J

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“…mNGS is an unbiased and rapid technique capable of detecting a broad range of pathogenic bacterial, viral, fungal, and parasite simultaneously in clinical samples. R-EBUS is a safe and valuable technique, which has been demonstrated to increase diagnostic yield for PPLs [29]. Current clinical use of R-EBUS is mainly in the localization of peripheral pulmonary lesions prior to biopsy.…”

Section: Discussionmentioning

confidence: 99%

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

Huang

et al. 2020

Canadian Respiratory Journal

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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.

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“…The bronchoscopic exam was primarily conducted by pulmonary fellows, as previously described, under the supervision of eight rotating pulmonary faculty in attendance [13, 14]. In brief, conventional bronchoscopy (BF-1 T260; Olympus Medical Systems Corp., Tokyo, Japan) was first performed to inspect the tracheobronchial tree after the patient received local anesthesia with lidocaine in the upper airway and intramuscular fentanyl for analgesia.…”

Section: Methodsmentioning

confidence: 99%

Radial endobronchial ultrasound-guided transbronchial biopsy for peripheral pulmonary malignancy: biopsy- or brushing-first?

Huang

Tsai

et al. 2019

BMC Pulm Med

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BackgroundRadial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy (TBB) is a common diagnostic modality for peripheral pulmonary lesions; however, there is uncertainty about the optimal sequence of TBB and bronchial brushing during the procedure. Thus, we aimed to investigate whether a biopsy-first or brushing-first strategy confers a better diagnostic yield and safety signal for R-EBUS-guided procedures for peripheral pulmonary malignancy.MethodsFrom January 2017 to June 2018, consecutive patients referred for R-EBUS-guided TBB and bronchial brushing of peripheral pulmonary lesions and with a final malignant diagnosis were included. Patients were placed in a biopsy-first (biopsy followed by brushing) or a brushing-first (brushing followed by biopsy) group. The outcomes of interest were the diagnostic yield and complication profile of the procedures. Multivariate logistic regression and subgroup analysis were used to assess the impact of the procedure strategy.ResultsA total of 438 patients were included and the diagnostic yield of R-EBUS-guided TBB plus brushing for peripheral pulmonary malignancy was 73%. The diagnostic yield was associated with the solid lesion appearance (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.08–3.75) and R-EBUS probe position within the lesion (OR 1.92; 95% CI 1.08–3.42), and the yield rates were comparable between the biopsy-first and brushing-first strategies. Moreover, the safety signal did not differ between the two groups.ConclusionsThe two procedure strategies were indistinguishable in terms of diagnostic efficacy and adverse events for patients with peripheral pulmonary malignancy. Current evidence indicates that in patients with peripheral pulmonary lesions suspected of being malignant, either biopsy-first or brushing-first is a viable and acceptable diagnostic strategy during R-EBUS-guided procedures.

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

Cited by 8 publications

References 18 publications

Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions

Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions

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

Radial endobronchial ultrasound-guided transbronchial biopsy for peripheral pulmonary malignancy: biopsy- or brushing-first?

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