Radial probe endobronchial ultrasound using a guide sheath for peripheral lung lesions in beginners

Jung Seop Eom,Yeon Joo Jeong,Jeong Ha Mok,Geewon Lee,Mi Hyun Kim,Min Ki Lee,Hyemi Park,Won-Young Kim,Ji Won Lee,Eun Jung Jo,Ki Uk Kim,Hye-Kyung Park,Insu Kim,Kwangha Lee

doi:10.1186/s12890-018-0704-7

Jung Seop Eom, Yeon Joo Jeong + Show 12 more

Open Access

https://doi.org/10.1186/s12890-018-0704-7

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Abstract

BackgroundThe diagnostic yields and safety profiles of transbronchial lung biopsy have not been evaluated in inexperienced physicians using the combined modality of radial probe endobronchial ultrasound and a guide sheath (EBUS-GS). This study assessed the utility and safety of EBUS-GS during the learning phase by referring to a database of performed EBUS-GS procedures.MethodsFrom December 2015 to January 2017, all of the consecutive patients who underwent EBUS-GS were registered. During the study period, two physicians with no previous experience performed the procedure. To assess the diagnostic yields, learning curve, and safety profile of EBUS-GS performed by these inexperienced physicians, the first 100 consecutive EBUS-GS procedures were included in the evaluation.ResultsThe overall diagnostic yield of EBUS-GS performed by two physicans in 200 patients with a peripheral lung lesion was 73.0%. Learning curve analyses showed that the diagnostic yields were stable, even when the procedure was performed by beginners. Complications related to EBUS-GS occurred in three patients (1.5%): pneumothorax developed in two patients (1%) and resolved spontaneously without chest tube drainage; another patient (0.5%) developed a pulmonary infection after EBUS-GS. There were no cases of pneumothorax requiring chest tube drainage, severe hemorrhage, respiratory failure, premature termination of the procedure, or procedure-related mortality.ConclusionsEBUS-GS is a safe and stable procedure with an acceptable diagnostic yield, even when performed by physicians with no previous experience.

Highlights

The diagnostic yields and safety profiles of transbronchial lung biopsy have not been evaluated in inexperienced physicians using the combined modality of radial probe endobronchial ultrasound and a guide sheath (EBUS-GS)
Until now, the pathological diagnosis of a peripheral lung lesion was usually made by transthoracic needle biopsy, surgical resection, or bronchoscopy; transbronchial lung biopsy using conventional bronchoscopy has a low diagnostic yield [1]
In a recent large-scale study of 965 patients, the rates of iatrogenic pneumothorax, pneumothorax requiring chest tube drainage, and pulmonary infection was 0.8%, 0.3%, and 0.5%, respectively, which were markedly lower than the rate related to transthoracic needle biopsy [1, 8, 9]

Summary

Introduction

The diagnostic yields and safety profiles of transbronchial lung biopsy have not been evaluated in inexperienced physicians using the combined modality of radial probe endobronchial ultrasound and a guide sheath (EBUS-GS). The pathological diagnosis of a peripheral lung lesion was usually made by transthoracic needle biopsy, surgical resection, or bronchoscopy; transbronchial lung biopsy using conventional bronchoscopy has a low diagnostic yield [1]. Technological advances have developed peripheral bronchoscopy as a useful and minimally invasive procedure [2,3,4]. Based on the results of previous studies, EBUS-GS for peripheral lung lesions is considered a relatively safe procedure with an acceptable diagnostic yield [6, 7]. Complications might be expected, when the procedure is performed by inexperienced physicians.

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