Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions.

STUDY OBJECTIVES The aim of our study was to compare the diagnostic yield of two bronchoscopic procedures: endobronchial ultrasound-driven transbronchial biopsy (EBUS-TBB) and transbronchial biopsy (TBB) in peripheral pulmonary lesions. DESIGN Prospective, randomized, blinded study. SETTING University Hospital of Rome, Italy. PATIENTS AND METHODS We examined 799 patients with peripheral lung lesions using bronchoscopy. Patients who could undergo a complete clinical diagnostic follow-up (n = 293) were enrolled in the study and randomly assigned to EBUS-TBB or TBB. We performed these two procedures on 221 patients (97 EBUS-TBB and 124 TBB). Patients in whom biopsies were not diagnostic underwent more invasive procedures to obtain a final diagnosis, and a complete follow-up was possible in 206 patients (87 EBUS-TBB and 119 TBB). RESULTS Lung cancer was diagnosed in 61 patients in the EBUS-TBB group and in 83 patients in the TBB group. Pulmonary diseases other than cancer were diagnosed in 26 patients and 36 patients, respectively. For patients with lung cancer, sensitivity was 0.79 in the EBUS group and 0.55 in the TBB group (p = 0.004), and accuracy was 0.85 and 0.69, respectively (p = 0.007). The analysis of a subset of patients with lesions > 3 cm showed no significant difference in diagnostic ability between the two procedures. In lesions < 3 cm, we found a considerable decline in TBB sensitivity and accuracy (0.31 and 0.50) while EBUS-TBB maintained their diagnostic yield (0.75 and 0.83) [p = 0.0002 and p = 0.001, respectively]. A similar difference was observed when we compared the sensitivity of the two procedures in lesions < 2 cm (0.23 vs 0.71, p < 0.001). CONCLUSIONS EBUS-TBB can be an important option in the early diagnosis of peripheral lung cancer, especially in small-sized lesions and in patients who are not eligible for surgery.

[1]  Atul C Mehta,et al.  Diagnosis of lung cancer: the guidelines. , 2003, Chest.

[2]  F. Herth,et al.  Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions , 2002, European Respiratory Journal.

[3]  M. Sugimoto,et al.  Usefulness of Endobronchial Ultrasonography for Transbronchial Lung Biopsies of Peripheral Lung Lesions , 2004, Respiration.

[4]  Horng-Chyuan Lin,et al.  Diagnostic value of endobronchial ultrasound-guided transbronchial lung biopsy in peripheral lung cancers. , 2004, Journal of the Formosan Medical Association = Taiwan yi zhi.

[5]  Douglas C McCrory,et al.  Noninvasive staging of non-small cell lung cancer: a review of the current evidence. , 2003, Chest.

[6]  Douglas C McCrory,et al.  Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. , 2003, Chest.

[7]  P. Vilmann,et al.  Endoscopic ultrasound-guided biopsy in the chest: little to lose, much to gain , 2005, European Respiratory Journal.

[8]  F. Herth,et al.  Ultrasound-guided transbronchial needle aspiration: an experience in 242 patients. , 2003, Chest.

[9]  P. Pairolero,et al.  Video-assisted thoracic surgical procedures: the Mayo experience. , 1996, Mayo Clinic proceedings.

[10]  C. Bolliger,et al.  The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. , 1999, Chest.

[11]  C. White,et al.  Transbronchial needle aspiration: guidance with CT fluoroscopy. , 2000, Chest.

[12]  J. Daurès,et al.  Serum fragment of cytokeratin subunit 19 measured by CYFRA 21-1 immunoradiometric assay as a marker of lung cancer. , 1993, Cancer research.

[13]  Downey Rj.  Complications after video-assisted thoracic surgery. , 1998 .

[14]  W. Scott,et al.  Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. , 1998, Chest.

[15]  S. Goldberg,et al.  CT fluoroscopy guidance for transbronchial needle aspiration: an experience in 35 patients. , 2001, Chest.

[16]  F. Donato,et al.  Clinical significance of a multiple biomarker assay in patients with lung cancer. A study with logistic regression analysis. , 1990, Chest.

[17]  Y. Matsuzaki,et al.  Pulmonary granuloma possibly caused by staples after video-assisted thoracoscopic surgery. , 2003, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[18]  S. Goldberg,et al.  Mediastinal lymphadenopathy: diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance-initial experience. , 2000, Radiology.

[19]  N. Kurimoto,et al.  Analysis of the internal structure of peripheral pulmonary lesions using endobronchial ultrasonography. , 2002, Chest.

[20]  Armin Ernst,et al.  Endobronchial ultrasound reliably differentiates between airway infiltration and compression by tumor. , 2003, Chest.

[21]  Dieter Ra,et al.  Complications and contraindications of thoracoscopy. , 1997 .

[22]  C. Beadsmoore,et al.  Classification, staging and prognosis of lung cancer. , 2003, European journal of radiology.

[23]  Franco Ameglio,et al.  Discriminant analysis on small cell lung cancer and non-small cell lung cancer by means of NSE and CYFRA-21.1. , 1995, The European respiratory journal.

[24]  G. Silvestri,et al.  Mediastinal staging of non-small-cell lung cancer. , 2001, Cancer control : journal of the Moffitt Cancer Center.

[25]  Masaki Murayama,et al.  Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. , 2004, Chest.

[26]  S. Spiro,et al.  Lung cancer--where are we today? Current advances in staging and nonsurgical treatment. , 2002, American journal of respiratory and critical care medicine.

[27]  P. Goldstraw,et al.  Intrapleural tumor dissemination after video-assisted thoracoscopic surgery metastasectomy. , 2003, The Annals of thoracic surgery.