Radial Probe Endobronchial Ultrasound-guided Transbronchial Lung Biopsy In The Diagnosis Of Peripheral Lung Lesions

Objective To explore the diagnostic value of endobronchial ultrasound(EBUS)-guided transbronchial lung biopsy(TBLB) for peripheral lung lesions(PPL), and assess the feasibility of EBUS echoic features as predictors as predictors of diagnostic yield of TBLB.Methods One hundred and ten patients［76males and34females, mean age (58±12)years,ranged from28-84years］with PPL confirmed by computered tomography(CT) were recruited in this study between August1st2012and November1st2013. All cases received bronchoscopy examinations and presented with roughly normal results. Seventy-two cases received EBUS examinations. For peripheral lesions with accessible EBUS images,blind biopsy was performed with biopsy forceps through pathways of the ultrasonic probe after the retreat of the probe. In those cases without accessible EBUS image, blind biopsy was performed based on the localization by image data. The other38cases without EBUS testing underwent blind biopsy on the localization by image data. Patients in whom EBUS-TBLB was nondiagnostic subsequently underwent surgical biopsy or computed tomography(CT)-guided transthoracic needle lung biopsy(TNLB), or a minimum of6months clinical and radiologic follow-up.Result For patients with lung cancer, sensitivity was0.65in the EBUS group and0.40in the TBLB group(p<0.05), and accuracy was0.85and0.29, respectively(p<0.05). The analysis of a subset of patients with lesions>3cm showed no significant difference in diagnostic ability between the two procedures. A similar difference was observed when we compared the sensitivity of the two procedures in lesions <2cm (0.67vs0.17, p=0.001). Diagnostic yield of EBUS-guided TBLB with variable lesion sizes and EBUS features in all PPLs were lesion diameter (≥3cm vs.<3cm;65.0%vs.65.6%, p>0.05), location of the EBUS probe (within vs. adjacent to lesions;75.7%vs.73.9%, p>0.05), echoic feature of the margin (noncontinuous vs. continuous;72.7%vs.77.8%,p<0.05) and lesion echogenicity (heterogeneous vs. homogeneous;84.2%vs.59.1%, p <0.05). No sever complication occurred.Conclusions TBLB for PPLs when guided by radial probe EBUS is a method of better diagnostic. PPL lesion size and some specific EBUS features correlate with the diagnostic yield of EBUS-guided TBLB for PPLs to a certain extent.