Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

Shotaro Okachi; Naoyuki Imai; Kazuyoshi Imaizumi; Shingo Iwano; Masahiko Ando; Tetsunari Hase; Hiromichi Aso; Masahiro Morise; Keiko Wakahara; Satoru Ito; Naozumi Hashimoto; Mitsuo Sato; Masashi Kondo; Yoshinori Hasegawa

doi:10.2169/internalmedicine.55.6341

ORIGINAL ARTICLES

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

Shotaro Okachi, Naoyuki Imai, Kazuyoshi Imaizumi, Shingo Iwano, Masahiko Ando, Tetsunari Hase, Hiromichi Aso, Masahiro Morise, Keiko Wakahara, Satoru Ito, Naozumi Hashimoto, Mitsuo Sato, Masashi Kondo, Yoshinori Hasegawa

Author information

Shotaro Okachi
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Naoyuki Imai
Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Japan
Kazuyoshi Imaizumi
Department of Respiratory Medicine, Fujita Health University, Japan
Shingo Iwano
Department of Radiology, Nagoya University Graduate School of Medicine, Japan
Masahiko Ando
Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
Tetsunari Hase
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Hiromichi Aso
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Masahiro Morise
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Keiko Wakahara
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Satoru Ito
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Naozumi Hashimoto
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Mitsuo Sato
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Masashi Kondo
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
Yoshinori Hasegawa
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan

Keywords: EBUS-GS, lung cancer, virtual bronchoscopic navigation, diagnostic factor, CT bronchus sign

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 13 Pages 1705-1712

DOI https://doi.org/10.2169/internalmedicine.55.6341

Details

Abstract

Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (≤30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT bronchus sign positivity, a solid nodule, and a probe position that was within the lesion.

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