Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial.

RATIONALE Endobronchial ultrasound (EBUS) and electromagnetic navigation bronchoscopy (ENB) have increased the diagnostic yield of bronchoscopic diagnosis of peripheral lung lesions. However, the role of combining these modalities to overcome each individual technique's limitations and, consequently, to further increase the diagnostic yield remains untested. OBJECTIVES A prospective randomized controlled trial involving three diagnostic arms: EBUS only, ENB only, and a combined procedure. METHODS All procedures were performed via flexible bronchoscopy and transbronchial forceps biopsies were obtained without fluoroscopic guidance. In the combined group, after electromagnetic navigation, the ultrasound probe was passed through an extended working channel to visualize the lesion. Biopsies were taken if ultrasound visualization showed that the extended working channel was within the target. Primary outcome was diagnostic yield. The reference "gold standard" was a surgical biopsy if bronchoscopic biopsy did not reveal a definite histological diagnosis compatible with the clinical presentation. Secondary outcomes were yields by size, lobar distribution, and lesion pathology. Complication rates were also documented. MEASUREMENTS AND MAIN RESULTS Of the 120 patients recruited, 118 had a definitive histological diagnosis and were included in the final analysis. The diagnostic yield of the combined procedure (88%) was greater than EBUS (69%) or ENB alone (59%; p = 0.02). The combined procedure's yield was independent of lesion size or lobar distribution. The pneumothorax rates ranged from 5 to 8%, with no significant differences between the groups. CONCLUSIONS Combined EBUS and ENB improves the diagnostic yield of flexible bronchoscopy in peripheral lung lesions without compromising safety.

[1]  A. Ernst,et al.  Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. , 2003, Chest.

[2]  F. Herth,et al.  Endobronchial ultrasound-guided transbronchial lung biopsy in fluoroscopically invisible solitary pulmonary nodules: a prospective trial. , 2006, Chest.

[3]  Koichi Yamazaki,et al.  Transbronchial biopsy using endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation. , 2005, Chest.

[4]  G. Sideris,et al.  The role of transbronchial needle aspiration in the diagnosis of peripheral lung masses or nodules. , 1995, The European respiratory journal.

[5]  Haya R Rubin,et al.  Patient satisfaction with bronchoscopy. , 2002, American journal of respiratory and critical care medicine.

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

[7]  S J Mentzer,et al.  The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases. , 1996, Journal of the American College of Surgeons.

[8]  A. Ernst,et al.  Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study. , 2006, Chest.

[9]  W. Baaklini,et al.  Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. , 2000, Chest.

[10]  A. Ernst,et al.  Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance , 2005 .

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

[12]  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.

[13]  F. Capron,et al.  Transbronchial biopsy without fluoroscopy: a five year experience in outpatients. , 1989, Thorax.

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

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

[16]  Y. Onodera,et al.  Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions , 2004, European Respiratory Journal.

[17]  B. A. Bush,et al.  Transbronchial biopsy without fluoroscopy. A seven-year perspective. , 1988, Chest.

[18]  Daniel Y Sze,et al.  CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. , 2003, Radiology.

[19]  Paul M. Suratt,et al.  Deaths and complications associated with fiberoptic bronchoscopy. , 1976, Chest.

[20]  M. Ohta,et al.  Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract. , 2000, Chest.

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

[22]  T. Gildea,et al.  Electromagnetic navigation diagnostic bronchoscopy: a prospective study. , 2006, American journal of respiratory and critical care medicine.

[23]  Yun-Chung Cheung,et al.  Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. , 2004, Chest.