Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

  • Moon, Seong Mi (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Junsu (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Byeong-Ho (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Um, Sang-Won (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hojoong (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, O Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyungjong (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2018.10.15
  • Accepted : 2019.05.02
  • Published : 2019.10.31
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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.

Keywords

References

  1. Politi K, Herbst RS. Lung cancer in the era of precision medicine. Clin Cancer Res 2015;21:2213-20. https://doi.org/10.1158/1078-0432.CCR-14-2748
  2. Folch E, Costa DB, Wright J, VanderLaan PA. Lung cancer diagnosis and staging in the minimally invasive age with increasing demands for tissue analysis. Transl Lung Cancer Res 2015;4:392-403. https://doi.org/10.3978/j.issn.2218-6751.2015.08.02
  3. Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000;117:1049-54. https://doi.org/10.1378/chest.117.4.1049
  4. Gildea TR, Mazzone PJ, Karnak D, Meziane M, Mehta AC. Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med 2006;174:982-9. https://doi.org/10.1164/rccm.200603-344OC
  5. Ishida T, Asano F, Yamazaki K, Shinagawa N, Oizumi S, Moriya H, et al. Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomised trial. Thorax 2011;66:1072-7. https://doi.org/10.1136/thx.2010.145490
  6. Chen A, Chenna P, Loiselle A, Massoni J, Mayse M, Misselhorn D. Radial probe endobronchial ultrasound for peripheral pulmonary lesions: a 5-year institutional experience. Ann Am Thorac Soc 2014;11:578-82. https://doi.org/10.1513/AnnalsATS.201311-384OC
  7. Chenna P, Chen AC. Radial probe endobronchial ultrasound and novel navigation biopsy techniques. Semin Respir Crit Care Med 2014;35:645-54. https://doi.org/10.1055/s-0034-1395499
  8. Anantham D, Koh MS, Ernst A. Endobronchial ultrasound. Respir Med 2009;103:1406-14. https://doi.org/10.1016/j.rmed.2009.04.010
  9. Ali MS, Trick W, Mba BI, Mohananey D, Sethi J, Musani AI. Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: a systematic review and metaanalysis. Respirology 2017;22:443-53. https://doi.org/10.1111/resp.12980
  10. Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011;37:902-10. https://doi.org/10.1183/09031936.00075310
  11. Fuso L, Varone F, Magnini D, Baldi F, Rindi G, Pagliari G, et al. Role of ultrasound-guided transbronchial biopsy in the diagnosis of peripheral pulmonary lesions. Lung Cancer 2013;81:60-4. https://doi.org/10.1016/j.lungcan.2013.04.004
  12. Evison M, Crosbie PA, Morris J, Martin J, Barber PV, Booton R. Can computed tomography characteristics predict outcomes in patients undergoing radial endobronchial ultrasoundguided biopsy of peripheral lung lesions? J Thorac Oncol 2014;9:1393-7. https://doi.org/10.1097/JTO.0000000000000249
  13. Wang Y, Mei Q, Ai YQ, Li RQ, Chang L, Li YF, et al. Identification of lung cancer oncogenes based on the mRNA expression and single nucleotide polymorphism profile data. Neoplasma 2015;62:966-73. https://doi.org/10.4149/neo_2015_117
  14. Yamada N, Yamazaki K, Kurimoto N, Asahina H, Kikuchi E, Shinagawa N, et al. Factors related to diagnostic yield of transbronchial biopsy using endobronchial ultrasonography with a guide sheath in small peripheral pulmonary lesions. Chest 2007;132:603-8. https://doi.org/10.1378/chest.07-0637
  15. Minezawa T, Okamura T, Yatsuya H, Yamamoto N, Morikawa S, Yamaguchi T, et al. Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study. BMC Med Imaging 2015;15:21. https://doi.org/10.1186/s12880-015-0060-5
  16. Eberhardt R, Ernst A, Herth FJ. Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm. Eur Respir J 2009;34:1284-7. https://doi.org/10.1183/09031936.00166708
  17. Izumo T, Sasada S, Chavez C, Matsumoto Y, Hayama M, Tsuchida T. The diagnostic value of histology and cytology samples during endobronchial ultrasound with a guide sheath. Jpn J Clin Oncol 2015;45:362-6. https://doi.org/10.1093/jjco/hyv004
  18. Yoshikawa M, Sukoh N, Yamazaki K, Kanazawa K, Fukumoto S, Harada M, et al. Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without X-ray fluoroscopy. Chest 2007;131:1788-93. https://doi.org/10.1378/chest.06-2506
  19. Chan A, Devanand A, Low SY, Koh MS. Radial endobronchial ultrasound in diagnosing peripheral lung lesions in a high tuberculosis setting. BMC Pulm Med 2015;15:90. https://doi.org/10.1186/s12890-015-0089-9
  20. Casutt A, Prella M, Beigelman-Aubry C, Fitting JW, Nicod L, Koutsokera A, et al. Fluoroscopic-guided radial endobronchial ultrasound without guide sheath for peripheral pulmonary lesions: a safe and efficient combination. Arch Bronconeumol 2015;51:338-43. https://doi.org/10.1016/j.arbres.2014.09.017
  21. Haidong H, Yunye N, Wei Z, Zarogoulidis P, Hohenforst- Schmidt W, Man YG, et al. Multiple guided technologies based on radial probe endobronchial ultrasound for the diagnosis of solitary peripheral pulmonary lesions: a single-center study. J Cancer 2017;8:3514-21. https://doi.org/10.7150/jca.20035
  22. Zhang SJ, Zhang M, Zhou J, Zhang QD, Xu QQ, Xu X. Comparison of radial endobronchial ultrasound with a guide sheath and with distance by thin bronchoscopy for the diagnosis of peripheral pulmonary lesions: a prospective randomized crossover trial. J Thorac Dis 2016;8:3112-8. https://doi.org/10.21037/jtd.2016.11.77
  23. Zhang SJ, Zhang M, Zhou J, Zhang QD, Xu QQ, Xu X. Radial endobronchial ultrasonography with distance measurement through a thin bronchoscope for the diagnosis of malignant peripheral pulmonary lesions. Transl Lung Cancer Res 2018;7:80-7. https://doi.org/10.21037/tlcr.2017.12.11
  24. Steinfort DP, Vincent J, Heinze S, Antippa P, Irving LB. Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: a randomized pragmatic trial. Respir Med 2011;105:1704-11. https://doi.org/10.1016/j.rmed.2011.08.008
  25. Xu CH, Yuan Q, Yu LK, Wang W, Lin Y. Endobronchial ultrasound transbronchial biopsy with guide-sheath for the diagnosis of solitary pulmonary nodules. Oncotarget 2017;8:58272-7. https://doi.org/10.18632/oncotarget.16813
  26. Kuo CH, Lin SM, Lee KY, Chung FT, Lo YL, Hsiung TC, et al. Endobronchial ultrasound-guided transbronchial biopsy and brushing: a comparative evaluation for the diagnosis of peripheral pulmonary lesions. Eur J Cardiothorac Surg 2014;45:894-8. https://doi.org/10.1093/ejcts/ezt472
  27. Gex G, Pralong JA, Combescure C, Seijo L, Rochat T, Soccal PM. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis. Respiration 2014;87:165-76. https://doi.org/10.1159/000355710
  28. Asano F, Eberhardt R, Herth FJ. Virtual bronchoscopic navigation for peripheral pulmonary lesions. Respiration 2014;88:430-40. https://doi.org/10.1159/000367900
  29. Tachihara M, Ishida T, Kanazawa K, Sugawara A, Watanabe K, Uekita K, et al. A virtual bronchoscopic navigation system under X-ray fluoroscopy for transbronchial diagnosis of small peripheral pulmonary lesions. Lung Cancer 2007;57:322-7. https://doi.org/10.1016/j.lungcan.2007.04.006
  30. Iwano S, Imaizumi K, Okada T, Hasegawa Y, Naganawa S. Virtual bronchoscopy-guided transbronchial biopsy for aiding the diagnosis of peripheral lung cancer. Eur J Radiol 2011;79:155-9. https://doi.org/10.1016/j.ejrad.2009.11.023
  31. Asano F, Shinagawa N, Ishida T, Shindoh J, Anzai M, Tsuzuku A, et al. Virtual bronchoscopic navigation combined with ultrathin bronchoscopy. A randomized clinical trial. Am J Respir Crit Care Med 2013;188:327-33. https://doi.org/10.1164/rccm.201211-2104OC
  32. Ozgul G, Cetinkaya E, Ozgul MA, Abul Y, Gencoglu A, Kamiloglu E, et al. Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions. Endosc Ultrasound 2016;5:189-95. https://doi.org/10.4103/2303-9027.183979
  33. Georgiou HD, Taverner J, Irving LB, Steinfort DP. Safety and efficacy of radial EBUS for the investigation of peripheral pulmonary lesions in patients with advanced COPD. J Bronchology Interv Pulmonol 2016;23:192-8. https://doi.org/10.1097/LBR.0000000000000288
  34. Jurado J, Saqi A, Maxfield R, Newmark A, Lavelle M, Bacchetta M, et al. The efficacy of EBUS-guided transbronchial needle aspiration for molecular testing in lung adenocarcinoma. Ann Thorac Surg 2013;96:1196-202. https://doi.org/10.1016/j.athoracsur.2013.05.066
  35. Khandhar SJ, Bowling MR, Flandes J, Gildea TR, Hood KL, Krimsky WS, et al. Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, multicenter NAVIGATE study. BMC Pulm Med 2017;17:59. https://doi.org/10.1186/s12890-017-0403-9
  36. Tsai TH, Yang CY, Ho CC, Liao WY, Jan IS, Chen KY, et al. Multi-gene analyses from waste brushing specimens for patients with peripheral lung cancer receiving EBUS-assisted bronchoscopy. Lung Cancer 2013;82:420-5. https://doi.org/10.1016/j.lungcan.2013.10.005
  37. Guisier F, Salaun M, Lachkar S, Lamy A, Piton N, Obstoy B, et al. Molecular analysis of peripheral non-squamous nonsmall cell lung cancer sampled by radial EBUS. Respirology 2016;21:718-26. https://doi.org/10.1111/resp.12737

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