Chest
BronchoscopyEndobronchial Ultrasound-Driven Biopsy in the Diagnosis of Peripheral Lung Lesions
Section snippets
Study Population
From January 2001 to September 2003, 3,184 consecutive unselected patients with suspected lung cancer were referred to our center of thoracic endoscopy for diagnostic bronchoscopy. Patients with peripheral lung lesions were investigated by means of chest CT.
We screened 799 patients with peripheral lung lesions; 506 patients were ineligible because they did not satisfy the inclusion criteria (Fig 1). Among the ineligible patients, we excluded 386 outpatients because of previously experienced low
RESULTS
Table 1shows the characteristics of the 206 patients evaluated in our study. Typical findings observed are shown inFigure 2. A definitive diagnosis was obtained by EBUS-TBB in 66 of 87 patients (75.8%) and by TBB in 62 of 119 patients (52.1%). In the study group, the diagnostic yields of EBUS-TBB were 69.2% (18 of 26 benign lesions) and 78.7% (48 of 61 malignant lesions). In the control group, the diagnostic yields of TBB were 44.4% (16 of 36 benign lesions) and 55.4% (46 of 83 malignant
DISCUSSION
The role of bronchoscopy in the diagnosis of small-sized peripheral lung lesions is controversial. Its sensitivity is low, and a negative result cannot rule out the presence of a malignancy. The possibility of using ultrasound has widened the bronchoscopic vision beyond the bronchial wall, with a substantial increase in diagnostic sensitivity.11
While the role of EBUS-driven biopsies in central malignancy diagnosis or in the evaluation of lymph nodes involvement is well established, there are
ACKNOWLEDGMENTS
We thank Dr. June Traicoff (20/20 GeneSystem, Inc, Rockville, MD), Professor Giovanni Schmid (C.U.B.E. Department of Cardiovascular and Respiratory Sciences, University of Rome La Sapienza, Forlanini Hospital, Italy), Dr. Enrico Girardi (Department of Epidemiology, National Institute for Infectious Diseases, IRCCS Lazzaro Spallanzani, Rome, Italy) for helpful discussion and critical review of the manuscript; and Dr. Andrea Stoler for text revision.
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2020, Annals of Thoracic SurgerySensitivity of Radial Endobronchial Ultrasound-Guided Bronchoscopy for Lung Cancer in Patients With Peripheral Pulmonary Lesions: An Updated Meta-analysis
2020, ChestCitation Excerpt :Stratification and meta-regression (for continuous variables) failed to demonstrate an association between reported sensitivity and single vs multicenter status, randomized vs prospective vs retrospective studies, consecutive case enrollment, prevalence of lung cancer, percentage of patients with bronchus sign, fluoroscopy use, guide sheath use, average lesion size, virtual bronchoscopy use, and follow-up time. Studies that used ROSE27-31 had a higher pooled sensitivity than studies that did not use ROSE6,25,26,32-78 (sensitivity, 0.79; 95% CI, 0.74-0.84 vs 0.72; 95% CI, 0.69-0.74, respectively; between-group heterogeneity P = .01) (e-Fig 5). Smaller studies (≤ 50 patients undergoing r-EBUS) had a higher sensitivity than larger studies (sensitivity, 0.78; 95% CI, 0.75-0.82 vs 0.70; 95% CI, 0.67-0.73, respectively; between-group heterogeneity P < .01) (e-Fig 6).
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