Abstract
BackgroundCurrent data for the utility of radial endobronchial ultrasound (EBUS) in investigating peripheral lung lesions (PLLs) has been restricted to populations with low pulmonary tuberculosis (TB) incidence. The aim of this study was to assess the diagnostic utility of radial EBUS with guide sheath in the diagnosis of peripheral lung lesions in Singapore, a high TB incidence setting.MethodsA post-hoc database analysis was performed. 123 consecutive patients with computed tomographic evidence of PLLs who underwent radial EBUS guided bronchoscopy were included.ResultsThe final diagnosis was malignancy in 76 cases and benign in 44 cases. Radial EBUS guided bronchoscopy had a sensitivity of 65.8 % for malignancy, positive predictive value of 100 %, negative predictive value of 62.9 %, and a diagnostic accuracy of 82.5 %. 22 patients had a final diagnosis of pulmonary TB. The diagnostic sensitivity for pulmonary TB was 77.3 %, with a positive predictive value of 100 %, negative predictive value of 95.2 % and a diagnostic accuracy of 95.8 %. Overall, 58.8 % of pulmonary TB cases relied on histology to make an early diagnosis.ConclusionRadial EBUS guided bronchosopy is useful in investigating PLLs in a high TB incidence setting. Our data also suggests that radial EBUS is a more rapid diagnosis technique for tuberculous lesions.
Highlights
Current data for the utility of radial endobronchial ultrasound (EBUS) in investigating peripheral lung lesions (PLLs) has been restricted to populations with low pulmonary tuberculosis (TB) incidence
Patient characteristics Overall, 123 patients underwent bronchoscopy with radial EBUS guidance. 3 patients were excluded from analysis as the final diagnosis could not be determined due to death (2 patients) or loss to follow-up (1 patient) [Table 1]
Radial EBUS for malignant lesions had a sensitivity of 65.8 %, positive predictive value of 100 %, negative predictive value of 62.9 %, and an overall diagnostic accuracy of 82.5 % [Table 2]
Summary
Current data for the utility of radial endobronchial ultrasound (EBUS) in investigating peripheral lung lesions (PLLs) has been restricted to populations with low pulmonary tuberculosis (TB) incidence. The aim of this study was to assess the diagnostic utility of radial EBUS with guide sheath in the diagnosis of peripheral lung lesions in Singapore, a high TB incidence setting. The diagnostic yield of flexible bronchoscopy in the biopsy of such lung lesions has been reported to be 54 % for malignant lesions and 41 % for benign lesions [3, 4]. The American College Of Chest Physicians Lung Cancer Guidelines has recommended using radial endobronchial ultrasound (EBUS) as an adjunct imaging modality for patients with peripheral lung nodules, where expertise and pulmonary tuberculosis (TB) can present as a peripheral lung lesion with varying disease activity: active infection, tuberculous granulomas, or inflammatory scars. Percutaneous lung biopsy and surgical resection are options that offer a high diagnostic yield, but these will
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