Cargando…

Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions

BACKGROUND: Radial endobronchial ultrasound (R‐EBUS) transbronchial lung biopsy (TBLB) improves the diagnostic yield from peripheral pulmonary lesions (PPLs). However, the small specimens obtained using small forceps through a guide sheath (GS) may impede diagnosis and molecular analysis. Here, we i...

Descripción completa

Detalles Bibliográficos
Autores principales: Park, Sojung, Yoon, Hee‐Young, Han, Yeji, Wang, Kyung Sook, Park, So Young, Ryu, Yon Ju, Lee, Jin Hwa, Chang, Jung Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263016/
https://www.ncbi.nlm.nih.gov/pubmed/32342673
http://dx.doi.org/10.1111/1759-7714.13446
_version_ 1783540732921905152
author Park, Sojung
Yoon, Hee‐Young
Han, Yeji
Wang, Kyung Sook
Park, So Young
Ryu, Yon Ju
Lee, Jin Hwa
Chang, Jung Hyun
author_facet Park, Sojung
Yoon, Hee‐Young
Han, Yeji
Wang, Kyung Sook
Park, So Young
Ryu, Yon Ju
Lee, Jin Hwa
Chang, Jung Hyun
author_sort Park, Sojung
collection PubMed
description BACKGROUND: Radial endobronchial ultrasound (R‐EBUS) transbronchial lung biopsy (TBLB) improves the diagnostic yield from peripheral pulmonary lesions (PPLs). However, the small specimens obtained using small forceps through a guide sheath (GS) may impede diagnosis and molecular analysis. Here, we investigated the diagnostic significance of additional conventional TBLB with standard forceps after R‐EBUS‐GS‐guided TBLB. METHODS: We retrospectively reviewed data from 55 patients who underwent conventional TBLB after R‐EBUS‐GS‐guided TBLB for PPL diagnosis. Procedures were performed on single PPLs with no visible lesions on bronchoscopy. In cases with inconclusive pathologic confirmation, final diagnoses were made based on pathologic specimens or clinical observations. RESULTS: The median size of the target lesions was 28 mm. The appearances on computed tomography images were solid (n = 45, 81.8%), part‐solid (n = 7, 12.7%), and cavitary nodules (n = 3, 5.5%). A computed tomography bronchus sign was present in 35 (63.6%) cases, and a radial probe was positioned within target lesion in 32 (58.2%) cases. R‐EBUS‐GS‐guided TBLB was diagnostic in 30 (54.5%) patients, and subsequent conventional TBLB yielded additional diagnostic information in 8 (14.5%) patients. Probe positioning within target lesions and the outer margin of PPLs more than 1 cm from pleura were significantly associated with enhanced diagnostic yield from the combined procedures. In conventional TBLB, probe positioning within target lesions (75.0% vs. 11.8%, P = 0.004) and characteristic of nonsolid nodules (83.3% vs. 15.8%, P = 0.006) were significantly associated with additional diagnostic utility. CONCLUSIONS: Conventional TBLB following R‐EBUS‐GS‐guided TBLB could be a useful procedure for diagnosing PPLs, especially for nonsolid nodules. KEY POINTS: Significant findings of the study: Additional conventional TBLB with standard forceps after R‐EBUS‐GS‐guided TBLB yielded an additional 14.5% diagnostic utility for peripheral pulmonary lesions. For conventional TBLB, probe positioning within target lesions and nonsolid nodules were significantly associated with additional diagnostic utility. What this study adds: Conventional TBLB with standard forceps after R‐EBUS‐GS‐guided TBLB is an effective and economically accessible diagnostic tool for peripheral pulmonary lesions.
format Online
Article
Text
id pubmed-7263016
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher John Wiley & Sons Australia, Ltd
record_format MEDLINE/PubMed
spelling pubmed-72630162020-06-03 Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions Park, Sojung Yoon, Hee‐Young Han, Yeji Wang, Kyung Sook Park, So Young Ryu, Yon Ju Lee, Jin Hwa Chang, Jung Hyun Thorac Cancer Original Articles BACKGROUND: Radial endobronchial ultrasound (R‐EBUS) transbronchial lung biopsy (TBLB) improves the diagnostic yield from peripheral pulmonary lesions (PPLs). However, the small specimens obtained using small forceps through a guide sheath (GS) may impede diagnosis and molecular analysis. Here, we investigated the diagnostic significance of additional conventional TBLB with standard forceps after R‐EBUS‐GS‐guided TBLB. METHODS: We retrospectively reviewed data from 55 patients who underwent conventional TBLB after R‐EBUS‐GS‐guided TBLB for PPL diagnosis. Procedures were performed on single PPLs with no visible lesions on bronchoscopy. In cases with inconclusive pathologic confirmation, final diagnoses were made based on pathologic specimens or clinical observations. RESULTS: The median size of the target lesions was 28 mm. The appearances on computed tomography images were solid (n = 45, 81.8%), part‐solid (n = 7, 12.7%), and cavitary nodules (n = 3, 5.5%). A computed tomography bronchus sign was present in 35 (63.6%) cases, and a radial probe was positioned within target lesion in 32 (58.2%) cases. R‐EBUS‐GS‐guided TBLB was diagnostic in 30 (54.5%) patients, and subsequent conventional TBLB yielded additional diagnostic information in 8 (14.5%) patients. Probe positioning within target lesions and the outer margin of PPLs more than 1 cm from pleura were significantly associated with enhanced diagnostic yield from the combined procedures. In conventional TBLB, probe positioning within target lesions (75.0% vs. 11.8%, P = 0.004) and characteristic of nonsolid nodules (83.3% vs. 15.8%, P = 0.006) were significantly associated with additional diagnostic utility. CONCLUSIONS: Conventional TBLB following R‐EBUS‐GS‐guided TBLB could be a useful procedure for diagnosing PPLs, especially for nonsolid nodules. KEY POINTS: Significant findings of the study: Additional conventional TBLB with standard forceps after R‐EBUS‐GS‐guided TBLB yielded an additional 14.5% diagnostic utility for peripheral pulmonary lesions. For conventional TBLB, probe positioning within target lesions and nonsolid nodules were significantly associated with additional diagnostic utility. What this study adds: Conventional TBLB with standard forceps after R‐EBUS‐GS‐guided TBLB is an effective and economically accessible diagnostic tool for peripheral pulmonary lesions. John Wiley & Sons Australia, Ltd 2020-04-27 2020-06 /pmc/articles/PMC7263016/ /pubmed/32342673 http://dx.doi.org/10.1111/1759-7714.13446 Text en © 2020 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Park, Sojung
Yoon, Hee‐Young
Han, Yeji
Wang, Kyung Sook
Park, So Young
Ryu, Yon Ju
Lee, Jin Hwa
Chang, Jung Hyun
Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
title Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
title_full Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
title_fullStr Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
title_full_unstemmed Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
title_short Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
title_sort diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263016/
https://www.ncbi.nlm.nih.gov/pubmed/32342673
http://dx.doi.org/10.1111/1759-7714.13446
work_keys_str_mv AT parksojung diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT yoonheeyoung diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT hanyeji diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT wangkyungsook diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT parksoyoung diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT ryuyonju diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT leejinhwa diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions
AT changjunghyun diagnosticyieldofadditionalconventionaltransbronchiallungbiopsyfollowingradialendobronchialultrasoundlungbiopsyforperipheralpulmonarylesions