Endobronchial ultrasound transbronchial lung biopsy with guide-sheath for the diagnosis of peripheral pulmonary lesions

Abstract

To evaluate the diagnostic yield and safety of endobronchial ultrasound transbronchial lung biopsy with guide-sheath (EBUS-GS-TBLB) in peripheral pulmonary lesions (PPL). Between August 2012 and March 2013, EBUS-GS-TBLB was performed in patients with PPL inaccessible by conventional bronchosopy in Shanghai Tenth People's Hospital. The diagnostic yield, safety and the associated factors were analyzed. Seventy five patients [46 males and 29 females, mean age (62.4 ± 11.4) years, ranged from 34 to 81 years] with PPL confirmed by computed tomography and conventional bronchosopy were recruited in this study. Mean bronchoscopic procedure time lasted for (15.4 ± 6.3) min. The average number of biopsy specimens obtained in each PPL was 4.6 ± 0.8. A total of 78 PPL were examined in 75 patients, and 68 PPL from 65 patients were detected by EBUS. Fifty eight PPL were diagnosed by EBUS-GS and the diagnostic rate was 74.4%. The diagnosis rate of malignancy was 84.4% (27/32) while that of benign disease was 67.4% (31/46). The most important factors that helped enhance EBUS-GS-TBLB diagnostic accuracy included lesion diameter greater than 20mm, EBUS probe within the lesions, the presence of a bronchus sign on CT imaging and central lesions. All the patients tolerated the procedure well. Mild bleeding was observed when performing biopsy in some patients. No pneumothorax, hemoptysis or other serious complications were observed. The procedure of EBUS-GS-TBLB was minimally invasive, had higher diagnostic rate and fewer complications. It was a safe and effective method to diagnose PPL, while careful selection of suitable cases could further improve the diagnostic accuracy.