Diagnosis of Lung Nodules With Peripheral/Radial Endobronchial Ultrasound-guided Transbronchial Biopsy

Abstract

: Pulmonary nodules are frequently encountered in clinical practice, but diagnostic sensitivity of traditional bronchoscopy remains less than desirable. Transbronchial biopsy (TBBX) under fluoroscopic guidance with flexible bronchoscopy has a sensitivity of 34% for lesions <20 mm and 63% for lesions >20 mm. Navigational technologies such as electromagnetic navigation bronchoscopy have increased the yields of TBBX to approximately 73%. We examine the sensitivity and factors that may impact the diagnostic yield of a similar technology, namely, radial endobronchial ultrasound (EBUS). : We conducted a retrospective review of 40 consecutive patients at a single institution who underwent TBBX of lung nodules ≤3 cm using radial EBUS guidance. We evaluated patient demographics, lung function, procedural sedation, nodule size and location, presence of a radiographic airway leading into the nodule (ie, bronchus sign), distance from the pleura, and metabolic activity on positron emission tomography scan. Nonmalignant biopsy results were compared with subsequent surgical resection or establishment of nonmalignancy based on radiographic stability over time. : Overall, the diagnostic yield of radial EBUS-guided bronchoscopy was 65%. Sensitivity was 71% in malignant disease and 82% in nonmalignant disease. Presence of a bronchus sign, nodule size, nodule location, distance from the pleura, and method of sedation did not have any impact on the yield of radial EBUS-guided TBBX (P≥0.21). : Lesion size, distance, presence of a computerized tomography bronchus sign, or lobar location may not impact the diagnostic yield of bronchoscopic biopsy of peripheral lung nodules with radial EBUS navigation.