Chest
Volume 132, Issue 2, August 2007, Pages 603-608
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Original Research
Interventional Pulmonology
Factors Related to Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography With a Guide Sheath in Small Peripheral Pulmonary Lesions

https://doi.org/10.1378/chest.07-0637Get rights and content

Study objectives

To evaluate factors predicting the diagnostic yield of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) in small peripheral pulmonary lesions (PPLs) ≤ 30 mm in mean diameter.

Design

Retrospective analysis.

Patients and methods

One hundred fifty-five consecutive patients with 158 small PPLs underwent TBB using EBUS-GS.

Results

A definitive diagnosis was established by TBB using EBUS-GS in 106 PPLs (67%). The diagnostic yield of PPLs ≤ 15 mm in mean diameter (40%) was significantly lower than that of PPLs > 15 mm and ≤ 30 mm in mean diameter (76%; p < 0.001). PPLs in which the probe was positioned within the PPL on the endobronchial ultrasonography (EBUS) image had a higher diagnostic yield (83%) than PPLs in which the probe was positioned adjacent to the PPL (61%) or outside the PPL (4%; p < 0.001). There were no significant differences in diagnostic yield for underlying disease, location, CT scan bronchus sign, operator, or type of EBUS probe. In the multivariate analysis, only the position of the probe (within or adjacent to the PPL when judged against outside the PPL) was determined to be a significant factor predicting diagnostic yield. On the other hand, a pathologic diagnosis was established with the first, second, third, fourth, and fifth biopsy specimens in 65%, 80%, 87%, 91%, and 97% of PPLs, respectively.

Conclusions

The position of the probe (ie, within or adjacent to the PPL) is a significant factor in predicting the diagnostic yield of TBB using EBUS-GS for small PPLs; the optimum number of biopsy specimens is at least five.

Section snippets

Patients

The medical records of 155 consecutive patients with 158 small PPLs (≤ 30 mm in mean diameter) who underwent TBB using EBUS-GS between August 2003 and March 2006 at Hokkaido University Hospital were retrospectively reviewed. In the same period, no patients with small PPLs underwent conventional TBB. PPLs were defined as lesions that were surrounded by pulmonary parenchyma and were endoscopically invisible (ie, no evidence of endobronchial lesion, extrinsic compression, submucosal tumor,

Results

The mean (± SD) diameter of the PPLs was 20.8 ± 6.1 mm (range, 9.5 to 30 mm). Of the 158 PPLs examined, 120 (76%) were examined with the 1.4-mm probe and 38 (34%) were examined with the 1.7-mm probe. A total of 134 PPLs (85%) were detected by EBUS. A definitive diagnosis was established in 106 PPLs (67%) by TBB using EBUS-GS (Table 1). Pathologic diagnosis and cytologic diagnosis were performed in 85 of 128 PPLs (66%) and 83 of 133 PPLs (62%), respectively.

Table 2 shows the features associated

Discussion

Several studies891011 have reported the efficacy and safety of TBB using EBUS-GS. However, as the diagnostic yield of TBB using EBUS-GS in PPLs still ranges from 58 to 77%,891011 the determination of the factors related to the diagnostic yield of TBB using EBUS in PPLs is important in increasing in the diagnostic yield. In general, the diagnostic yield is lower in small PPLs; in our preliminary report on TBB using EBUS-GS,9 small PPLs < 20 mm in mean diameter had a lower diagnostic yield than

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The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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