Adjacent angle size correlates with diagnostic sensitivity of endobronchial ultrasonography with a guide sheath

Background An association exists among the diagnostic yield of transbronchial biopsy using endobronchial ultrasonography with a guide sheath (EBUS-GS-TBB) and several factors, such as simple within or adjacent endobronchial ultrasonography (EBUS) findings. Here, we aimed to investigate whether more detailed EBUS findings affect the diagnostic yield of lung cancer in EBUS-GS-TBB. Methods We conducted this retrospective single-center cohort study, enrolling consecutive patients with lung cancer who underwent EBUS-GS-TBB. The primary outcome was examination of predictive factors affecting the diagnostic yield of lung cancer using EBUS-GS-TBB. The secondary outcome was a subgroup analysis of within and adjacent lesions. The adjacent angle was defined as the angle formed by the midpoint of the probe and the two points where the edge of the probe and shadow of the tumor intersected. Results Of the 179 lesions investigated, 140 (78.2%) were diagnosed using EBUS-GS-TBB. The diagnostic yields of within and adjacent lesions were 91.6% and 51.7%, respectively. In the multivariable analysis, within lesions had significantly higher diagnostic yields than did the adjacent lesions (P<0.001). The adjacent angle was larger in lesions diagnosed using EBUS-GS-TBB than in undiagnosed lesions (P=0.003). In adjacent lesions, the diagnostic yields were 75.0% and 36.1% for lesions ≥180° and <180°, respectively. Conclusions In adjacent lesions, the diagnostic yields differed significantly depending on the adjacent angle. Even if EBUS findings are adjacent, the operator should identify the branch of the bronchus with a greater adjacent angle. Future studies should investigate improvements in diagnostic yields via additional procedures for lesions with small adjacent angles.

[1]  K. Yasufuku,et al.  Advances in interventional diagnostic bronchoscopy for peripheral pulmonary lesions , 2019, Expert review of respiratory medicine.

[2]  L. Yarmus,et al.  Standard Bronchoscopy With Fluoroscopy vs Thin Bronchoscopy and Radial Endobronchial Ultrasound for Biopsy of Pulmonary Lesions: A Multicenter, Prospective, Randomized Trial , 2018, Chest.

[3]  M. Kondo,et al.  Risk factors for infectious complications after endobronchial ultrasound guided transbronchial biopsy , 2018, Lung Cancer.

[4]  Geewon Lee,et al.  Radial probe endobronchial ultrasound using a guide sheath for peripheral lung lesions in beginners , 2018, BMC Pulmonary Medicine.

[5]  K. Hiroshima,et al.  The efficacy of transbronchial needle aspiration with endobronchial ultrasonography using a guide sheath for peripheral pulmonary lesions suspected to be lung cancer. , 2017, Respiratory investigation.

[6]  T. Tsuchida,et al.  Additional transbronchial needle aspiration through a guide sheath for peripheral pulmonary lesions that cannot be detected by radial EBUS , 2017, The clinical respiratory journal.

[7]  Guiqi Wang,et al.  Endobronchial ultrasonography using a guide sheath technique for diagnosis of peripheral pulmonary lesions , 2017, Endoscopic ultrasound.

[8]  Thomas R. Gildea,et al.  Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, multicenter NAVIGATE study , 2017, BMC Pulmonary Medicine.

[9]  W. Trick,et al.  Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis , 2017, Respirology.

[10]  Shinji Sasada,et al.  Diagnostic utility of endobronchial ultrasound with a guide sheath under the computed tomography workstation (ziostation) for small peripheral pulmonary lesions , 2017, The clinical respiratory journal.

[11]  M. Nishimura,et al.  Usefulness of Endobronchial Ultrasonography With a Guide Sheath and Virtual Bronchoscopic Navigation for Ground-Glass Opacity Lesions. , 2017, The Annals of thoracic surgery.

[12]  Naoki Yamamoto,et al.  Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study , 2015, BMC Medical Imaging.

[13]  K. Kiura,et al.  Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for diagnosis of lung cancer. , 2015, Respiratory investigation.

[14]  T. Tsuchida,et al.  Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations. , 2015, Journal of thoracic disease.

[15]  F. Herth,et al.  Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions , 2014, Respiration.

[16]  M. Nishimura,et al.  Endobronchial Ultrasonography with a Guide Sheath for Pure or Mixed Ground-Glass Opacity Lesions , 2014, Respiration.

[17]  I. Vollmer,et al.  Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Lesions. A Controlled Study With Fluoroscopy , 2013 .

[18]  J. Hardie,et al.  A randomised trial of endobronchial ultrasound guided sampling in peripheral lung lesions. , 2011, Lung cancer.

[19]  M. Nishimura,et al.  Factors related to diagnostic yield of transbronchial biopsy using endobronchial ultrasonography with a guide sheath in small peripheral pulmonary lesions. , 2007, Chest.

[20]  Paolo Battistoni,et al.  Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. , 2005, Chest.

[21]  T. Miyazawa,et al.  Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. , 2004, Chest.

[22]  Kenji Suzuki,et al.  Clinicopathologic features of peripheral squamous cell carcinoma of the lung. , 2004, The Annals of thoracic surgery.

[23]  J. Fujita,et al.  Expression of carcinoembryonic antigen in peripheral- or central-located small cell lung cancer: its clinical significance. , 2001, Japanese journal of clinical oncology.

[24]  M. Gaeta,et al.  Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy. , 1991, AJR. American journal of roentgenology.

[25]  D. Naidich,et al.  Solitary Pulmonary Nodules: CT-Bronchoscopic Correlation , 1988 .