Transbronchial Catheter Aspiration and Transbronchial Needle Aspiration in the Diagnostic Workup of Peripheral Lung Lesions

Franke, KJ; Hein, Melanie; Domanski, U; Nilius, Georg; Schroeder, Maik; Wohlschlaeger, Jeremias; Theegarten, Dirk

doi:10.1007/s00408-015-9763-1

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…The results showed that there was no statistical difference in the diagnosis yield of the “within” PPLs or “outside” lesions with the guided sheath (GS)-TBNA needle aspiration biopsy 27. By comparing the diagnostic yield of GS-TBNA, transbronchial catheter aspiration (TBCA) and TBBX in the PPLs, Franke et al 28 found that GS-TBNA had a higher diagnostic yield for malignant PPLs, and its diagnostic yield was about twice that of TBBX in combination with the result of TBCA. A recent meta-analysis of 18 clinical studies showed that C-TBNA was significantly better than TBBX in the diagnosis of PPLs 29.…”

Section: Discussionmentioning

confidence: 99%

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Huang¹,

Huang²,

Ning³

et al. 2019

J. Cancer

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Background: The diagnosis of peribronchial pulmonary lesions located in the tertiary bronchi, also known as segmental bronchi, as well as, the 4th order and 5th order segmental bronchi is very difficult. Histopathological specimens cannot be easily obtained by endobronchial biopsies (EBBX) due to the patent but small segmental bronchial lumen. The aim of the present study was to evaluate the diagnostic accuracy and safety of the novel technique with radial probe endobronchial ultrasound (R-EBUS) assisted conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of solitary peribronchial pulmonary lesions located in segmental bronchi from 3th to 5th order.Methods: From December 2014 to December 2015, 16 patients with solitary peribronchial pulmonary lesions in the segmental bronchi from 3th to 5th order confirmed by computed tomography (CT) were enrolled. The lesions were located using radial probe endobronchial ultrasound (R-EBUS) to determine the sites of conventional transbronchial needle aspiration (C-TBNA), then, histopathological specimens were obtained using the technique of C-TBNA. The final pathological diagnosis was made based on the findings from the surgical specimens. Statistical analyses were performed for specimen results and complications.Results: On pathological evaluation, 14 of the 16 specimens were malignant, including 8 adenocarcinomas, 4 squamous cell carcinomas, and 2 small cell carcinomas, while 2 were non-malignant diseases. The diagnostic accuracy rate, sensitivity and missed diagnosis rates were 87.5%, 87.5% and 12.5%, respectively. When Combined the results of cytology with histologic samples obtained from C-TBNA the total diagnostic accuracy rate, sensitivity and missed diagnosis rate were 93.75%, 93.75% and 6.25%, respectively. There were 2 cases of bleeding complications >5 mL after C-TBNA, and both were resolved with endobronchial management.Conclusions: The combination of R-EBUS with C-TBNA was advantageous and safe for the diagnosis of solitary peribronchial pulmonary lesions located in the segmental bronchi. However, possible bleeding complications should be anticipated with needle aspiration. Further verification of this combined application should be investigated in larger clinical trials.

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Section: Discussionmentioning

confidence: 99%

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Huang¹,

Huang²,

Ning³

et al. 2019

J. Cancer

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show abstract

“…The results showed that there was no statistical difference in the diagnosis yield of the "within" PPLs or "outside" lesions with the guided sheath (GS)-TBNA needle aspiration biopsy [27]. By comparing the diagnostic yield of GS-TBNA, transbronchial catheter aspiration (TBCA) and TBBX in the PPLs, Franke et al [28] found that GS-TBNA had a higher diagnostic yield for malignant PPLs, and its diagnostic yield was about twice that of TBBX in combination with the result of TBCA. A recent meta-analysis of 18 clinical studies showed that C-TBNA was significantly better than TBBX in the diagnosis of PPLs [29].…”

Section: Discussionmentioning

confidence: 99%

Radial Probe Endobronchial Ultrasound Assisted Conventional Transbronchial Needle Aspiration in the Diagnosis of Solitary Peribronchial Pulmonary Lesion Located in the Segmental Bronchi

2018

Respirology

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Background:The diagnosis of peribronchial pulmonary lesions located in the tertiary bronchi, also known as segmental bronchi, as well as, the 4th order and 5th order segmental bronchi is very difficult. Histopathological specimens cannot be easily obtained by endobronchial biopsies (EBBX) due to the patent but small segmental bronchial lumen. The aim of the present study was to evaluate the diagnostic accuracy and safety of the novel technique with radial probe endobronchial ultrasound (R-EBUS) assisted conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of solitary peribronchial pulmonary lesions located in segmental bronchi from 3th to 5th order. Methods: From December 2014 to December 2015, 16 patients with solitary peribronchial pulmonary lesions in the segmental bronchi from 3th to 5th order confirmed by computed tomography (CT) were enrolled. The lesions were located using radial probe endobronchial ultrasound (R-EBUS) to determine the sites of conventional transbronchial needle aspiration (C-TBNA), then, histopathological specimens were obtained using the technique of C-TBNA. The final pathological diagnosis was made based on the findings from the surgical specimens. Statistical analyses were performed for specimen results and complications. Results: On pathological evaluation, 14 of the 16 specimens were malignant, including 8 adenocarcinomas, 4 squamous cell carcinomas, and 2 small cell carcinomas, while 2 were non-malignant diseases. The diagnostic accuracy rate, sensitivity and missed diagnosis rates were 87.5%, 87.5% and Ivyspring International Publisher 12.5%, respectively. When Combined the results of cytology with histologic samples obtained from C-TBNA the total diagnostic accuracy rate, sensitivity and missed diagnosis rate were 93.75%, 93.75% and 6.25%, respectively. There were 2 cases of bleeding complications >5 mL after C-TBNA, and both were resolved with endobronchial management. Conclusions: The combination of R-EBUS with C-TBNA was advantageous and safe for the diagnosis of solitary peribronchial pulmonary lesions located in the segmental bronchi. However, possible bleeding complications should be anticipated with needle aspiration. Further verification of this combined application should be investigated in larger clinical trials.

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“… 9 , 20 , 23 , 24 , 27 In addition, the use of a multitool strategy may be more effective than single-tool strategies. 20 , 24 , 26 , 27 However, some operators may be concerned that use of the transbronchial needle could increase complication rates. The safety and relative accuracy of different biopsy tool strategies used in conjunction with ENB have yet to be examined in a large, prospective, multicenter study.…”

mentioning

confidence: 99%

“…14,15 Operator and procedural factors may further impact outcomes, such as user experience, 16 the use of rapid on-site evaluation (ROSE), 11,17,18 and concurrent imaging. 15,[19][20][21][22] Previous studies suggest that the diagnostic yield of bronchoscopy, including conventional bronchoscopy, 9,23,24 virtual bronchoscopic navigation, 25,26 and ENB, 20,27,28 may be related to the choice of biopsy tool. In particular, several studies have reported higher diagnostic yield with transbronchial needle aspiration than with transbronchial forceps biopsy or brushing.…”

mentioning

confidence: 99%

“…In particular, several studies have reported higher diagnostic yield with transbronchial needle aspiration than with transbronchial forceps biopsy or brushing. 9,20,23,24,27 In addition, the use of a multitool strategy may be more effective than single-tool strategies. 20,24,26,27 However, some operators may be concerned that use of the transbronchial needle could increase complication rates.…”

mentioning

confidence: 99%

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The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Gildea

Folch

Khandhar³

et al. 2020

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is impacted by biopsy tool strategy and rapid on-site evaluation (ROSE) use. This analysis evaluates usage patterns, accuracy, and safety of tool strategy and ROSE in a multicenter study. Methods: NAVIGATE (NCT02410837) evaluates ENB using the superDimension navigation system (versions 6.3 to 7.1). The 1-year analysis included 1215 prospectively enrolled subjects at 29 United States sites. Included herein are 416 subjects who underwent ENB-aided biopsy of a single lung lesion positive for malignancy at 1 year. Use of a restricted number of tools (only biopsy forceps, standard cytology brush, and/or bronchoalveolar lavage) was compared with an extensive multimodal strategy (biopsy forceps, cytology brush, aspirating needle, triple needle cytology brush, needle-tipped cytology brush, core biopsy system, and bronchoalveolar lavage). Results: Of malignant cases, 86.8% (361/416) of true positive diagnoses were obtained using extensive multimodal strategies. ROSE was used in 300/416 cases. The finding of malignancy by ROSE reduced the total number of tools used. A malignant ROSE call was obtained in 71% (212/300), most (88.7%; 188/212) by the first tool used (49.5% with aspirating needle, 20.2% with cytology brush, 17.0% with forceps). True positive rates were highest for the biopsy forceps (86.9%) and aspirating needle (86.6%). Use of extensive tool strategies did not increase the rates of pneumothorax (5.5% restricted, 2.8% extensive) or bronchopulmonary hemorrhage (3.6% restricted, 1.1% extensive). Conclusion: These results suggest that extensive biopsy tool strategies, including the aspirating needle, may provide higher true positive rates for detecting lung cancer without increasing complications.

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Transbronchial Catheter Aspiration and Transbronchial Needle Aspiration in the Diagnostic Workup of Peripheral Lung Lesions

Abstract: TBB, TBNA and TBCA are complementary to one another. Combining the three techniques, even allows transbronchial specimen collection of PLL <3 cm in diameter at conventional bronchoscopy.

Cited by 4 publications

References 31 publications

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Radial Probe Endobronchial Ultrasound Assisted Conventional Transbronchial Needle Aspiration in the Diagnosis of Solitary Peribronchial Pulmonary Lesion Located in the Segmental Bronchi

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

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