The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions

Background: Radial-probe endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) is invaluable in the diagnosis of peripheral pulmonary lesions (PPLs); however, in certain instances, the procedure has to be repeated because of initial non-diagnostic procedure (s). Little if any literature has been published on this issue. Therefore, the aim of this study was to investigate the utility of repeat rEBUS-guided TBB in achieving a definitive diagnosis of PPLs. Methods: All patients who underwent rEBUS-guided TBB of PPLs at National Taiwan University Hospital between 2011 and 2015 and had a repeat procedure after non-diagnostic initial procedures were identified as the study subjects. The primary outcome of interest was the diagnostic yield of repeat rEBUS-guided TBB for PPLs. Also, we sought to discover features associated with the yield of repeat procedures. Results: Forty-three (11%) out of 384 patients with initial non-diagnostic TBB were included for analysis. A diagnosis of PPLs was able to be confirmed with repeat TBB in 23 (53%) patients. The pathology of the first TBB was significantly associated with the yield of repeat procedures(P = 0.011). Further, patients with normal lung tissue in initial pathology rarely (2/12, 17%) had a definite diagnosis on repeat TBB. Yet, patients with pathology showing atypical cells and other non-specific findings were more likely (21/31, 68%) to obtain a confirmed diagnosis. The diagnostic yield of repeat procedures was not affected by the size, location or CT appearance of the lesions, or position of the rEBUS probe. No death or other serious adverse events occurred with the repeat rEBUS-guided procedures. Conclusions: If clinically indicated, it is reasonable to repeat rEBUS-guided TBB after an initial non-diagnostic procedure as the diagnostic yield will be at least 50% and the side effect profile is favorable.