Tuberc Respir Dis.  2019 Jul;82(3):201-210. 10.4046/trd.2018.0073.

Utility of Radial Probe Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Diffuse Lung Lesions

Affiliations
  • 1Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University College of Medicine, Daegu, Korea. solar903@chol.com

Abstract

BACKGROUND
Radial probe endobronchial ultrasound (R-EBUS) is widely used for diagnosing peripheral pulmonary lesions. However, the utility of R-EBUS-guided transbronchial lung biopsy (TBLB) for diffuse lung lesions (DLLs) remains unknown. We designed this study to evaluate the utility of R-EBUS-guided TBLB in DLLs.
METHODS
This retrospective study enrolled patients admitted from January 2016 to November 2017 who underwent TBLB for DLLs. The R-EBUS-guided TBLB and blind TBLB groups were compared. DLL was defined as any lung disorder that involved more than one segment of the lung. In both the groups, fluoroscopy and guided sheath were not used during TBLB.
RESULTS
A total of 127 patients underwent TBLB for DLLs (67 patients in the R-EBUS-guided TBLB group and 60 in the blind TBLB group). There were no differences in age, sex, and comorbid illnesses between the two groups. Furthermore, there was no difference in the TBLB diagnostic yield of the two groups (p=0.660) although more samples were collected from the R-EBUS-guided TBLB group (p=0.003). Procedure time was significantly longer in the R-EBUS-guided TBLB group than in the blind TBLB group (p<0.001). Thus, incidence of pneumothorax was significantly lower in the R-EBUS-guided TBLB group than in the blind TBLB group (p=0.032).
CONCLUSION
Diagnostic yield in DLLs did not differ between the R-EBUS-guided TBLB and blind TBLB groups. Findings show that R-EBUS-guided TBLB in DLLs may reduce risk of pneumothorax.

Keyword

Biopsy; Bronchoscopy; Ultrasonography; Pneumothorax

MeSH Terms

Biopsy*
Bronchoscopy
Fluoroscopy
Humans
Incidence
Lung*
Pneumothorax
Retrospective Studies
Ultrasonography

Figure

  • Figure 1 Consolidation. Case 1 was that of a 74-year-old man with dyspnea. (A) Chest computed tomography (CT) showing lobar consolidation with air bronchogram in the right upper lobe. (B) Radial probe endobronchial ultrasound (R-EBUS) in the posterior segmental bronchus of the right upper lobe revealing a homogenous, isoechoic tissue-like pattern around the probe and some hyperechoic dots away from the probe. (C) Histopathologic specimen from transbronchial lung biopsy (TBLB) showing chronic inflammation with organizing pneumonia pattern (H&E stain, ×200). His final diagnosis was organizing pneumonia secondary to bacterial infection. Case 2 was that of a 73-year-old man with febrile sensation. (D) Chest CT showing segmental consolidation in the lingular segment of the left upper lobe. (E) R-EBUS revealing a homogenous and isoechoic pattern around the probe. (F) Histopathologic specimen from TBLB showing round yeast-like fungi (Gomori's methenamine silver stain, ×400). His final diagnosis was pulmonary cryptococcosis.

  • Figure 2 Ground-glass opacity (GGO). Case 3 was that of an 82-year-old man with dyspnea. (A) Chest computed tomography (CT) showing GGO in the posterior segment of the right upper lobe. (B) Radial probe endobronchial ultrasound (R-EBUS) revealing a mixed blizzard sign containing a heterogeneous acoustic shadow with hyperechoic dots, linear arcs, and vessels. (C) Histopathologic specimen from transbronchial lung biopsy (TBLB) showing organizing pneumonia pattern with focal atypical cells (H&E, ×200). His final diagnosis was cryptogenic organizing pneumonia. Case 4 was that of a 79-year-old man with febrile sensation. (D) Chest CT showing GGO in the right lower lobe. (E) R-EBUS in the anterobasal segmental bronchus of the right lower lobe, revealing a mixed blizzard sign. (F) Histopathologic specimen from TBLB showing organizing pneumonia (H&E stain, ×200). His final diagnosis was organizing pneumonia secondary to bacterial infection.


Cited by  2 articles

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Kyungjong Lee
Tuberc Respir Dis. 2019;82(3):264-265.    doi: 10.4046/trd.2019.0042.

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