Comparison of diagnostic yield and safety profile of radial endobronchial ultrasound-guided bronchoscopic lung biopsy with computed tomography-guided percutaneous needle biopsy in evaluation of peripheral pulmonary lesions: A randomized controlled trial

被引:21
作者
Gupta, Ayush [1 ]
Suri, Jagdish Chander [1 ]
Bhattacharya, Dipak [1 ]
Sen, Manas Kamal [1 ]
Chakrabarti, Shibdas [1 ]
Singh, Abhijeet [1 ]
Adhikari, Tulsi [2 ]
机构
[1] Vardhman Mahavir Med Coll & Safdarjung Hosp, Dept Pulm Crit Care & Sleep Med, New Delhi, India
[2] Indian Council Med Res, Natl Inst Med Stat, New Delhi, India
关键词
Bronchoscopy; computed tomography; peripheral pulmonary lesions; radial endobronchial ultrasound;
D O I
10.4103/lungindia.lungindia_208_17
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: Peripheral pulmonary lesions (PPLs) pose a diagnostic challenge, and the optimal investigation in many such cases remains unclear. Computed tomography (CT)-guided percutaneous needle biopsy (CT-PNB) has been the modality of choice for such lesions with a high diagnostic accuracy but with high rates of pneumothorax. Endobronchial ultrasound (EBUS) with a radial probe is an alternate diagnostic modality with increased diagnostic yield of bronchoscopy in the evaluation of PPL. We conducted a randomized controlled trial comparing the diagnostic accuracy and complication rates of radial EBUS with CT-guided lung biopsy for the evaluation of PPL. Methods: Fifty patients with PPL surrounded by lung parenchyma on all sides were randomly assigned to either radial EBUS or CT-PNB group (25 each). Results: Both groups had similar clinicoradiologic characteristics. The diagnostic accuracy of radial EBUS was comparable to CT-PNB with no statistically significant difference (72 vs. 84%; P = 0.306). However, the yield was significantly lower in right upper lobe lesions (20% vs. 83.3%; P = 0.03). CT-PNB group had significantly higher pneumothorax rates than radial EBUS (20% vs. 0%; P = 0.03). The lesions that were more than 2 cm, those with ultrasound feature of continuous hyperechoic margin around the lesion (P = 0.007), and the position of the ultrasound probe within the lesion (P < 0.001) were associated with a higher diagnostic yield with radial EBUS. Conclusion: Our findings suggest that radial EBUS is a safer investigation than CT-PNB with a comparable diagnostic accuracy for PPL not abutting the chest wall (CTRI/2017/02/007762).
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页码:9 / 15
页数:7
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