Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial

Abstract

BackgroundThe evaluation of solitary pulmonary lesions (SPL) requires a balance between procedure-related morbidity and diagnostic yield, particularly in areas where tuberculosis (TB) is endemic. Data on ultrathin bronchoscopy (UB) for this purpose is limited. To evaluate feasibility and safety of UB compared to SB for diagnosis of SPL in a TB endemic region.MethodsIn this prospective randomised trial we compared diagnostic yield and adverse events of UB with standard-size bronchoscopy (SB), both combined with fluoroscopy, in a cohort of patients with SPL located beyond the visible range of SB.ResultsWe included 40 patients (mean age 55.2 years, 45 % male) with malignant SPL (n = 16; 40 %), tuberculous SPL (n = 11; 27.5 %) and other benign SPL (n = 13; 32.5 %). Mean procedure time in UB and SB was 30.6 and 26.0 min, respectively (p = 0.15). By trend, adverse events were recorded more often with UB than with SB (30.0 vs. 5.0 %, p = 0.091), including extensive coughing (n = 2), blocked working channel (n = 2), and arterial hypertension requiring therapeutic intervention (n = 1), all with UB. The overall diagnostic yield of UB compared to SB was 55.0 % vs. 80.0 %, respectively (p = 0.18). Sensitivity for the diagnosis of malignancy of UB and SB was 50.0 % and 62.5 %, respectively (p = 0.95).ConclusionUB is not superior to SB for the evaluation of SPL in a region endemic with tuberculosis, when combined with fluoroscopic guidance only.Trial registrationClinicalTrials.gov (Identifier: NCT02490059).Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0225-1) contains supplementary material, which is available to authorized users.

Ultrathin bronchoscope combined with virtual bronchoscopic navigation and endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions with or without fluoroscopy: A randomized trial

“…The diagnostic yields of the UTB and the standard‐size bronchoscope were 55.0% and 80.0%, respectively ( p = 0.18). In that study, UTB was not superior to standard‐size bronchoscopy for the evaluation of PPLs when combined with fluoroscopic guidance because of the limitations of the small, 1.2‐mm working channel, which limited the ability to sample specimens and had poor suction capability 32 . Currently available UTBs share this limitation; however, the novel UTB used in the present study has a 1.7‐mm working channel that is able to accommodate a wider variety of bronchoscopic instruments, including a 1.5‐mm biopsy forceps, which is an important feature for the diagnosis of PPLs.…”

Diagnostic value of ultrathin bronchoscopy in peripheral pulmonary lesions: a narrative review

“…Franzen et al conducted a small pilot study comparing bronchoscopy using a conventional 2.8-mm ultrathin bronchoscope with a 1.2-mm working channel to standardsize bronchoscopes with external diameters of 5.0-6.0 mm for diagnosing PPLs in a region endemic for tuberculosis (32). Forty patients were enrolled and assigned to either ultrathin or standard-size bronchoscope groups, of whom 28% were ultimately diagnosed with tuberculosis.…”

Bronchoscopic techniques in the management of patients with tuberculosis

“…Other Authors reported on the utility of cytological specimens containing typical granulomas collected through fluoroscopicallyguided brushing and transbronchial needle aspiration in the diagnosis of TB-related peripheral pulmonary nodules and masses (Tamura et al, 2010;Reichenberger et al, 1999;Gasparini et al, 1995;Jafari et al, 2013;Franzen et al, 2016) (Figure 1). Franzen et al, who carried out a randomized controlled trial in a high TB incidence country, failed to demonstrate a higher yield of brushing and TBLB performed with an ultrathin bronchocope versus samplings obtained with a standard bronchoscope (Franzen et al, 2016).…”