J Korean Med Sci.  2021 Jun;36(24):e176. 10.3346/jkms.2021.36.e176.

Utility of Radial Probe Endobronchial Ultrasound Guided Transbronchial Lung Biopsy in Bronchus Sign Negative Peripheral Pulmonary Lesions

• Hong KS
• Lee KH
• Chung JH
• Shin KC
• Jin HJ
• Jang JG
• Ahn JH

• KMID: 2516766
• DOI: http://doi.org/10.3346/jkms.2021.36.e176

Abstract

Background
The presence of the bronchus sign on chest computed tomography is associated with an increased diagnostic yield of radial probe endobronchial ultrasound– guided transbronchial lung biopsy (RP-EBUS-TBLB). However, the utility of RP-EBUS-TBLB for bronchus sign negative peripheral pulmonary lesions (PPLs) remains unknown. We investigated the utility of RP-EBUS-TBLB in bronchus sign negative PPLs.
Methods
We retrospectively reviewed data from 109 patients who underwent RP-EBUS for bronchus sign negative PPLs from January 2019 to August 2020. TBLB was performed using RP-EBUS with a guide sheath and without fluoroscopy. The EBUS visualization and TBLB diagnostic yields were assessed. Multivariable logistic regression analyses were used to identify factors affecting the EBUS visualization and diagnostic yields.
Results
The EBUS visualization yield was 74.1% (68/109). Of the 109 lung lesions, 92 were definitively diagnosed. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 50.5% (55/109), 34.9% (29/83), 100% (26/26), 100% (29/29), and 32.5% (26/80), respectively. In multivariable analyses, the size of the lesion (≥ 20 mm; odds ratio [OR], 2.62; 95% confidence interval [CI], 1.16–5.93; P = 0.021) and the distance from the pleura (> 10 mm; OR, 2.37; 95% CI, 1.02–5.52; P = 0.045) were associated with EBUS visualization. Regarding diagnostic yield, having the probe within the lesion (OR, 28.50; 95% CI, 6.26–129.85; P < 0.001) and a solid lesion (OR, 14.58; 95% CI, 2.64–80.38; P = 0.002) were associated with diagnostic success. Pneumothorax and hemoptysis occurred in 3.7% (4/109) and 0.9% (1/109), respectively, of the patients.
Conclusion
RP-EBUS-TBLB using a GS can be considered a diagnostic method in bronchus sign negative solid PPLs. Having the probe within the lesion and a solid lesion were important for diagnostic success. Complication rates were acceptable.

Keyword

Diagnosis; Biopsy; Bronchoscopy; Ultrasonography

Figure

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  Fig. 1 Study flowchart.EBUS = endobronchial ultrasound, PPL = peripheral pulmonary lesion, RP-EBUS = radial probe EBUS.

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  Fig. 2 Representative cases. (A) CT scan showing a 12 mm sized nodule. (B) CT scan showing a 32 mm sized solid nodule. (C) RP-EBUS in the superior segment of the right lower lobe showing an EBUS image within the lesion and biopsy revealed squamous cell carcinoma. (D) RP-EBUS in the superior segment of the right lower lobe showing an EBUS image adjacent to the lesion and biopsy revealed small cell carcinoma.CT = computed tomography, EBUS = endobronchial ultrasound, RP-EBUS = radial probe EBUS.

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