Abstract
BackgroundRecent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions. In some cases, however, it is difficult to obtain adequate biopsy samples for pathological diagnosis. Adequate prediction of the diagnostic accuracy of TBB with EBUS-GS is important before deciding whether bronchoscopy should be performed.MethodsWe retrospectively reviewed 149 consecutive patients who underwent TBB with EBUS-GS for small-sized peripheral lung lesions (≤30 mm in diameter) from April 2012 to March 2013. We conducted an exploratory analysis to identify clinical factors that can predict an accurate diagnosis by TBB with EBUS-GS. All patients underwent thin-section chest computed tomography (CT) scans (0.5-mm slices), and the CT bronchus sign was evaluated before bronchoscopy in a group discussion. The final diagnoses were pathologically or clinically confirmed in all studied patients (malignant lesions, 110 patients; benign lesions, 39 patients).ResultsThe total diagnostic yield in this study was 72.5 % (95 % confidence interval: 64.8–79.0 %). Lesion size, lesion visibility on chest X-ray, and classification of the CT bronchus sign were factors significantly associated with the definitive biopsy result in the univariate analysis. In the multivariate analysis, only the CT bronchus sign remained as a significant predictive factor for successful bronchoscopic diagnosis. The CT bronchus sign was also significantly associated with the EBUS findings of the lesions.ConclusionOur results suggest that the CT bronchus sign is a powerful predictive factor for successful TBB with EBUS-GS.
Highlights
Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions
Patient characteristics and details of lesions We retrospectively reviewed 149 consecutive patients who underwent TBB with endobronchial ultrasound (EBUS)-GS
Our study shows that the computed tomography (CT) bronchus sign as evaluated by thin-section CT (TSCT) is the most powerful predictive factor for successful bronchoscopic diagnosis of small peripheral lesions
Summary
Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions. Recent studies of lung cancer screening by low-dose computed tomography (CT) have demonstrated a definite advantage for detecting early-stage lung cancer [1,2,3]. Both chronic obstructive pulmonary disease and pulmonary fibrosis, rapidly growing health problems especially in the older population, are frequently associated with lung cancer [4, 5]. Recent studies have shown that a final diagnosis cannot be reached by bronchoscopy even with the most advanced techniques available today in a certain percentage of patients [8]
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