Abstract
Background and Objective: Radial endobronchial ultrasound with a guide sheath (EBUS-GS) has improved the diagnostic accuracy of transbronchial biopsy (TBB) for malignant peripheral pulmonary nodules (PPNs). Studies on its utility have mainly included solid PPNs but considering that more ground glass opacities (GGOs) are being detected these days, we aimed to find an approach that can further improve the efficacy of the procedure based on nodule characteristics.
Methods: This was a retrospective study on 212 malignant PPNs that underwent EBUS-GS TBB at the National Cancer Center, Tokyo, Japan, from April 2012 to March 2013.
Results. The PPNs measured 20 mm (mean, SD 5.45) and were mainly adenocarcinoma. EBUS-GS established the diagnosis in 68%, with a positive likelihood ratio of 2.57 (1.42 to 4.64) and a negative likelihood ratio of 0.37 (0.27 to 0.52). For solid PPNs (N=117), significant improvement of yield to 78% was noted for centrally located nodules (p= 0.01) and when the EBUS probe was within the tumor (p= 0.01). For GGO (N= 95), factors that significantly increased the yield to 75-77% were central location (p= 0.05), EBUS probe within the tumor (p= 0.01), and when at least 5 histologic samples were collected (p= 0.01). Nodule size, lung field, and GS size did not contribute substantially to the efficacy of the procedure.
Conclusion. TBB with EBUS-GS is a satisfactory diagnostic procedure for both solid and GGO peripheral lung cancer but better accuracy can be expected for proximally located PPNs and those that can be precisely detected by EBUS. For GGO, adequate tissue sampling is recommended.
- © 2014 ERS
