Lung Cancer. 2013 Jul;81(1):60-4. doi: 10.1016/j.lungcan.2013.04.004.

Role of ultrasound-guided transbronchial biopsy in the diagnosis of peripheral pulmonary lesions.

Fuso L1, Varone F, Magnini D, Baldi F, Rindi G, Pagliari G, Inchingolo R, Smargiassi A.

1Pulmonary Medicine Unit, Università Cattolica del Sacro Cuore, University Hospital A. Gemelli, Rome, Italy. leofuso@rm.unicatt.it

 

ABSTRACT

INTRODUCTION: Endobronchial ultrasound (EBUS) can be used as an alternative to fluoroscopy to visualize a peripheral pulmonary lesion (PPL) and to provide an image guidance for transbronchial biopsy (TBB). The aim of this study was to verify the accuracy of EBUS-guided TBB in the diagnosis of PPLs.

METHODS: All the patients with CT-scan evidence of PPL who underwent bronchoscopy with EBUS in the period between 2008 and 2011 were retrospectively evaluated. EBUS was performed using a radial-type miniature ultrasound probe. Once obtained an EBUS image of the PPL, we measured the distance of the PPL from the outer orifice of the working channel of the bronchoscope in order to perform TBB at PPL site.

RESULTS: A total of 662 patients were examined. The mean diameter of lesions was 36 ± 20 mm. PPLs were visualized in 494 patients (75%) and the TBB was performed in 479 patients. Thirty-two patients were lost in follow-up and data from 447 patients were analyzed. TBB results were 255 cancers and 192 non-malignant lesions. The final diagnosis reported was 359 cases of cancer and 88 of benign lesion. EBUS-guided TBB had a sensitivity of 71% for the diagnosis of cancer, a negative predictive value of 46% and an overall diagnostic accuracy of 77%.

CONCLUSIONS: These data obtained from a large series of patients and using an original method show that EBUS represents a valid support to bronchoscopy and that the EBUS-guided TBB has a high diagnostic yield in the diagnosis of PPLs.

Copyright © 2013 Elsevier Ireland Ltd.

PMID: 23639784

 

Supplement

A peripheral pulmonary lesion (PPL) can represent a real diagnostic challenge. Although lung cancer might be suspected on some radiological features of the lesion, a histological diagnosis is often mandatory and needs invasive approaches. In this setting, bronchoscopy is usually performed and endobronchial ultrasound (EBUS) can be used as a valid alternative to fluoroscopy in providing an image guidance for transbronchial biopsy (TBB).

EBUS uses a radial-type miniature ultrasound 20 MHz probe (UMS20-20R, Olympus, Tokyo, Japan) with an outer diameter of 1.7 mm, connected to an endoscopic ultrasound system (EUM30S, Olympus, Tokyo, Japan). The EBUS probe is introduced through the working channel of the bronchoscope to explore all the branches of the bronchial tree potentially directed towards the lesion. Thus, it is possible to obtain an ultrasound image of the peripheral lesion, as shown in the following figure.

Leonello Fuso-fig1In this  study, we verified the accuracy of EBUS-guided TBB in the diagnosis of PPLs. The histological results derived from TBB have been compared with the final diagnosis obtained with other invasive procedures and/or a clinical-radiological follow-up of the patients.

The main results obtained in our study are reported in the following algorithm and table.Leonello Fuso-fig2

 

Leonello Fuso-fig3

EBUS-guided TBB had a sensitivity of 71% for the diagnosis of cancer (255 TBB positive for cancer out of 359 patients with a final diagnosis of cancer). The negative predictive value was 46% because 88 of 192 TBB negative specimens have been finally proved as true negatives for cancer. The overall diagnostic accuracy of EBUS-guided TBB was 77% (255 cases of cancer and 88 true negatives for cancer out of 447 patients who performed TBB).

No major complication was reported during or after the endoscopic procedures. A mild or moderate self-limiting bleeding was frequently observed. Only 8 patients (1.7%) experienced a pneumothorax which resolved spontaneously without the insertion of a drainage catheter.

In conclusion, this study is a further confirmation of the important role of EBUS-guided TBB in patients with PPLs. These lesions, while being beyond the limits of vision of the bronchoscope, can be visualized with a high frequency by the ultrasound probe. Our results, obtained in a large series of patients, are similar to those reported in literature and show that EBUS-guided TBB has a high diagnostic yield with a low incidence of complications.

 

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