Tuberc Respir Dis.  2019 Oct;82(4):319-327. 10.4046/trd.2018.0082.

Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

• Moon SM
• Choe J
• Jeong BH
• Um SW
• Kim H
• Kwon OJ
• Lee K

• KMID: 2459056
• DOI: http://doi.org/10.4046/trd.2018.0082

Abstract

BACKGROUND
Radial probe endobronchial ultrasound (R-EBUS), is effective for tissue diagnosis of lung lesions. We evaluated the diagnostic performance of R-EBUS both a guide-sheath and fluoroscopy and identified factors associated with accurate diagnosis. The feasibility of molecular and genetic testing, using specimens obtained by R-EBUS, was also investigated.
METHODS
The study retrospectively reviewed 211 patients undergoing R-EBUS without a guide-sheath and fluoroscopy, June 2016-May 2017. After excluding 27 patients of which the target lesion was not reached, 184 were finally included. Multivariate logistic regression was used, to identify factors associated with accurate diagnosis.
RESULTS
Among 184 patients, R-EBUS-guided biopsy diagnosed malignancy in 109 patients (59%). The remaining 75 patients (41%) with non-malignant results underwent additional work-ups, and 34 were diagnosed with malignancy. Based on final diagnosis, diagnostic accuracy was 80% (136/170), and sensitivity and specificity for malignancy were 76% (109/143) and 100% (27/27), respectively. In multivariate analysis, peripheral location (adjusted odds ratio [aOR], 3.925; 95% confidence interval [CI], 1.203-12.811; p=0.023), and central position of the probe (aOR, 2.435; 95% CI, 1.424-7.013; p=0.035), were associated with accurate diagnosis of malignancy. Molecular and genetic analyses were successful, in all but one case, with inadequate specimens.
CONCLUSION
R-EBUS-guided biopsy without equipment, is effective for tissue diagnosis. Peripheral location and central position of the radial probe, were crucial for accurate diagnosis. Performance of molecular and genetic testing, using samples obtained by R-EBUS, was satisfactory.

Keyword

Diagnosis; Ultrasonography; Ultrasonics; Bronchoscopy; Lung Neoplasms

MeSH Terms

Biopsy
Bronchoscopy
Diagnosis
Fluoroscopy
Genetic Testing
Humans
Logistic Models
Lung
Lung Neoplasms
Multivariate Analysis
Odds Ratio
Retrospective Studies
Sensitivity and Specificity
Ultrasonics
Ultrasonography*

Figure

• 

  Figure 1 (A) Bronchus sign on computed tomography. They were categorized into three types. “Central” type was defined as the nearest bronchus, clearly reached the target lesion and “invisible” type was defined as no bronchus, was detected around the lesion and otherwise, was categorized as “adjacent.” (B) Bronchus sign on ultrasound. They were categorized into two types. The radial probe within the center of the target lesion, and completely surrounded by the lesion was classified as “within”. The radial probe adjacent to the target lesion, and not completely in contact with the lesion, was defined as “adjacent.”

• 

  Figure 2 Initial result and final diagnosis. R-EBUS: radial probe endobronchial ultrasound; NSCLC: non-small cell lung cancer; SCLC: small cell lung cancer; LN: lymph node; PCNB: percutaneous needle biopsy.

• 

  Figure 3 Diagnostic performance of R-EBUS-guided biopsy, based on clinical characteristics in patients with malignancy (n=143). R-EBUS: radial probe endobronchial ultrasound; GGN: ground glass nodule; CT: computed tomography; US: ultrasonography.

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