Clinical outcomes of radial probe endobronchial ultrasound using a guide sheath for diagnosis of peripheral lung lesions in patients with pulmonary emphysema

Kyu Min Lee,Geewon Lee,Kwangha Lee,Eun-Jung Jo,Ahreum Kim,Hye-Kyung Park,Ji Won Lee,Min Ki Lee,Jung Seop Eom,Ki Uk Kim,Mi Hyun Kim,Jeongha Mok,Yeon Joo Jeong

doi:10.1186/s12931-019-1149-0

Abstract

BackgroundGenerally, structural destruction of lung parenchyma, such as pulmonary emphysema, is considered to be related to the low diagnostic yields and high complication rates of lung biopsies of peripheral lung lesions. Currently, little is known about the clinical outcomes of using endobronchial ultrasound with a guide sheath (EBUS-GS) to diagnose peripheral lesions in patients with emphysema.MethodsThis retrospective study was performed to identify the clinical outcomes of EBUS-GS in patients with pulmonary emphysema. This study included 393 consecutive patients who received EBUS-GS between February 2017 and April 2018. The patients were classified according to the severity of their emphysema, and factors possibly contributing to a successful EBUS-GS procedure were evaluated.ResultsThe overall diagnostic yield of EBUS-GS in patients with no or mild emphysema was significantly higher than in those with moderate or severe pulmonary emphysema (78% vs. 61%, P = 0.007). There were no procedure-related complications. The presence of a bronchus sign on CT (P < 0.001) and a “within the lesion” status on EBUS (P = 0.009) were independently associated with a successful EBUS-GS procedure. Although the diagnostic yield of EBUS-GS in patients with moderate-to-severe emphysema was relatively low, a bronchus sign and “within the lesion” status on EBUS were contributing factors for a successful EBUS-GS.ConclusionsEBUS-GS is a safe procedure with an acceptable diagnostic yield, even when performed in patients with pulmonary emphysema. The presence of a bronchus sign and “within the lesion” status on EBUS were predictors of a successful procedure.

Highlights

Structural destruction of lung parenchyma, such as pulmonary emphysema, is considered to be related to the low diagnostic yields and high complication rates of lung biopsies of peripheral lung lesions
Study population Of the 393 study patients who received Endobronchial ultrasound (EBUS)-GS, pulmonary emphysema was found in 129 patients (33%)
Many physicians hesitate to make pathologic diagnoses of peripheral lung lesions in patients with pulmonary emphysema because of its associated complications and low diagnostic yields; our results suggest that a pathological diagnosis of a peripheral lung lesion can be made safely using endobronchial ultrasound with a guide sheath (EBUS-GS)

Summary

Introduction

Structural destruction of lung parenchyma, such as pulmonary emphysema, is considered to be related to the low diagnostic yields and high complication rates of lung biopsies of peripheral lung lesions. The use of LDCT to screen high-risk populations has resulted in a decrease in lung cancer mortality of 20% compared with screening using chest radiographs, high false-positive rates and the low prevalence of lung cancer are still considered major limitations to its widespread use [2, 3]. In this respect, pulmonary physicians and radiologists may find it challenging to distinguish early stage lung cancer from a benign lung nodule on LDCT [4, 5]. High-risk individuals who receive LDCT screening for lung cancer have a smoking history of more than 30 pack-years [7], and because of the possibility of reduced lung function or advanced lung destruction such as that due to pulmonary emphysema, a less invasive strategy for collecting lung tissue is required [8]

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