Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for peripheral pulmonary malignancy

Chun-Ta Huang; Lih-Yu Chang; Chung-Yu Chen; Sheng-Yuan Ruan; Ching-Kai Lin; Yi-Ju Tsai; Chao-Chi Ho; Chong-Jen Yu

doi:10.1183/23120541.00267-2021

Endobronchial ultrasound-guided transbronchial biopsy with or without a guide sheath for peripheral pulmonary malignancy

ERJ Open Res. 2021 Sep 27;7(3):00267-2021. doi: 10.1183/23120541.00267-2021. eCollection 2021 Jul.

Authors

Chun-Ta Huang^{1

2}, Lih-Yu Chang³, Chung-Yu Chen⁴, Sheng-Yuan Ruan¹, Ching-Kai Lin⁵, Yi-Ju Tsai⁶, Chao-Chi Ho¹, Chong-Jen Yu¹

Affiliations

¹ Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
³ Dept of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan.
⁴ Dept of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.
⁵ Dept of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
⁶ Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.

Abstract

Endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) is a common procedure used to diagnose peripheral pulmonary lesions (PPLs). However, existing literature did not conclusively show a difference in the ability of EBUS-TBB with and without a guide sheath (GS) to diagnose PPLs. This multicenter cohort study enrolled patients presenting for EBUS-TBB of PPLs that finally proved to be malignant. The diagnostic yield and complication rate were compared between patients undergoing EBUS-TBB with and without a GS (EBUS-TBB+GS versus EBUS-TBB-GS). A propensity score matching method was used to balance differences of pertinent clinical features between the two groups. The original cohort consisted of 975 patients (556 in EBUS-TBB-GS; 419 in EBUS-TBB+GS). GS guidance was more likely to be used with smaller (40 mm versus 44 mm) and middle or lower lobe (60% versus 35%) lesions. After propensity score matching, 720 (360 in each group) patients were included; the diagnostic yields for PPLs were 79% and 78% for EBUS-TBB-GS and EBUS-TBB+GS groups, respectively (p=0.649). The complication rates (5.8% versus 7.2% for bleeding; 0.6% versus 1.9% for pneumothorax) appeared to be lower in the EBUS-TBB+GS group, but the differences did not reach statistical significance. The procedure time was significantly longer in the EBUS-TBB+GS group than in the EBUS-TBB-GS group (29 min versus 24 min; p<0.001). In conclusion, adding a GS to EBUS-TBB did not improve the diagnostic yield for malignant PPLs. GS guidance was seemingly associated with a lower number of complications after TBB but contributed significantly to a longer procedure time.