Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: a randomized pragmatic trial.
Author(s): Steinfort DP, Vincent J, Heinze S, Antippa P, Irving LB
Publication: Respir Med, 2011, Vol. 105, Page 1704-11
PubMed ID: 21875783 PubMed Review Paper? No
Purpose of Paper
This paper compared the diagnostic accuracy and effects of clinical factors on sensitivity of endobronchial ultrasound transbronchial lung biopsies (EBUS-TBLB) and computed tomography-guided percutaneous needle biopsies (CT-PNB) of peripheral pulmonary lesions.
Conclusion of Paper
The diagnostic accuracy was comparable between EBUS-TBLB and CT-PNB (87.5% versus 93.3%), but CT-PNB resulted in a significantly higher rate of complications. Although no clinical factors affected the diagnostic accuracy of CT-PNB, EBUS-TBLB sensitivity was highest when the lesion was located by the probe or when the diagnosis was lung cancer.
Studies
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Study Purpose
This study compared the diagnostic accuracy of EBUS-TBLB and CT-PNB of peripheral pulmonary lesions and investigated the effects of clinical factors on the sensitivity of each method. A single physician performed all 32 EBUS-TBLB by localization of the lesion by EBUS, replacement of the EBUS probe with a sampling device (forceps or cytology brush), and sampling under fluoroscope. Bronchial washings were collected after EBUS-TBLB. Sixteen CT-PNB were performed by six different individuals by localization of the lesion using limited CT followed by insertion of the 19-gauge (G) coaxial and 20-G core needle in 15 cases and a 17-G coaxial and 18-G core needle in one case. Diagnosis included 22 adenocarcinomas, 9 squamous cell lung carcinomas, 3 small cell lung carcinomas, 2 large cell lung carcinomas, 3 non-small cell lung carcinomas, 1 mycobacterium tuberculosis, 1 nodular lymphoid hyperplasia, 1adenosquamous lung carcinoma, 1 chondroid hamartoma, 3 inflammatory masses, and 1 metastatic breast carcinoma. Biopsy fixation and staining methods were not specified.
Summary of Findings:
The diagnostic accuracy was comparable between EBUS-TBLB and CT-PNB (87.5% versus 93.3%). No clinical factors affected the diagnostic accuracy of CT-PNB and EBUS-TBLB was not affected by lesion size, lobar location, and the presence of CT-bronchus sign; but sensitivity of EBUS-TBLB was highest when the lesion was located by the probe (100% versus 50%, P=0.001) or when the diagnosis was lung cancer (24 of 28 versus 1 of 3, P=0.025).. The ability to locate the lesion with the probe during EBUS-TBLB was also associated with a diagnosis of primary lung cancer (19 of 28 versus 0 of 4, P=0.020). Although not significant, a trend to increased sensitivity was observed for lesions located 6 cm or less from the pulmonary hilum (20 of 21 versus 5 of 8 when more than 6 cm). However, CT-PNB resulted in a significantly higher rate of complications than EBUS-TBLB (27% versus 3%, P=0.03).
Biospecimens
Preservative Types
- Other Preservative
- Formalin
Diagnoses:
- Neoplastic - Carcinoma
- Other diagnoses
- Neoplastic - Benign
Platform:
Analyte Technology Platform Morphology Light microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Ultrasound-guided biopsy
CT-guided biopsy
Biospecimen Acquisition Biospecimen location ≤6 cm from pulmonary hilum
>6 cm from pulmonary hilum
Preaquisition Prognostic factor ≤2 cm lesion
>2 cm lesion