Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer

BACKGROUND: Although the use of radial endobronchial ultrasound (R‐EBUS) with a guide sheath has shown improved diagnostic capability in peripheral pulmonary lesions, its utility is still low due to variable performance. To overcome its limitation, we evaluated the feasibility and efficacy of R‐EBUS combined with transbronchial biopsy (TBB) under fluoroscopic guidance. METHODS: We retrospectively reviewed medical records of 74 patients with non‐small cell lung cancer (NSCLC) who underwent R‐EBUS combined with TBB or TBB alone as a diagnostic technique. Subjects were grouped according to the diagnostic modality used (R‐EBUS combined with TBB vs. TBB alone). Each group was matched for age, sex, and location of the biopsy. The chi‐square test and paired t‐test were used to compare characteristics and identify factors that affected the diagnostic yield. RESULTS: The mean age of the study cohort was 67.4 ± 12.8 years, with 21 (56.8%) men and 16 (43.2%) women in each group. The lesion size was significantly smaller in the R‐EBUS group (23.6 vs. 33.9, P < 0.001). The diagnostic yield with the combined use of R‐EBUS and TBB (27/37, 72.9%) was significantly higher than that with standard TBB alone (22/37, 59.4%). Lung lesions with a positive bronchus sign were associated with a higher diagnostic yield (odds ratio = 3.52 [1.17–10.62]; P = 0.025). CONCLUSIONS: The combination of R‐EBUS with TBB resulted in a higher diagnostic yield than either technique alone. Thus, the addition of R‐EBUS biopsy would be helpful to improve the diagnostic yield of TBB. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: The combination of R‐EBUS with TBB under fluoroscopic guidance improved the diagnostic yield of PPLs compared to TBB alone. A tissue diagnosis was more likely in pulmonary lesions with the air‐bronchus sign. WHAT THIS STUDY ADDS: The use of R‐EBUS could help improve the low diagnostic yield of TBB under fluoroscopic guidance without increasing the incidence of complications.