title: Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions.
abstract: OBJECTIVE
  The aim of our study was to compare the diagnostic yield of two bronchoscopic procedures: endobronchial ultrasound-driven transbronchial biopsy (EBUS-TBB) and transbronchial biopsy (TBB) in peripheral pulmonary lesions.
  
  
  METHODS
  Prospective, randomized, blinded study.
  
  
  METHODS
  University Hospital of Rome, Italy.
  
  
  METHODS
  We examined 799 patients with peripheral lung lesions using bronchoscopy. Patients who could undergo a complete clinical diagnostic follow-up (n = 293) were enrolled in the study and randomly assigned to EBUS-TBB or TBB. We performed these two procedures on 221 patients (97 EBUS-TBB and 124 TBB). Patients in whom biopsies were not diagnostic underwent more invasive procedures to obtain a final diagnosis, and a complete follow-up was possible in 206 patients (87 EBUS-TBB and 119 TBB).
  
  
  RESULTS
  Lung cancer was diagnosed in 61 patients in the EBUS-TBB group and in 83 patients in the TBB group. Pulmonary diseases other than cancer were diagnosed in 26 patients and 36 patients, respectively. For patients with lung cancer, sensitivity was 0.79 in the EBUS group and 0.55 in the TBB group (p = 0.004), and accuracy was 0.85 and 0.69, respectively (p = 0.007). The analysis of a subset of patients with lesions > 3 cm showed no significant difference in diagnostic ability between the two procedures. In lesions < 3 cm, we found a considerable decline in TBB sensitivity and accuracy (0.31 and 0.50) while EBUS-TBB maintained their diagnostic yield (0.75 and 0.83) [p = 0.0002 and p = 0.001, respectively]. A similar difference was observed when we compared the sensitivity of the two procedures in lesions < 2 cm (0.23 vs 0.71, p < 0.001).
  
  
  CONCLUSIONS
  EBUS-TBB can be an important option in the early diagnosis of peripheral lung cancer, especially in small-sized lesions and in patients who are not eligible for surgery.
authors.affiliation: UBE Department of Cardiovascular and Respiratory Sciences, University of Rome La Sapienza, Italy. zpaone1023@yahoo.com.it
authors.forename: Gregorino
authors.initials: G
authors.lastname: Paone
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lucantoni
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dello Iacono
authors.forename: Paolo
authors.initials: P
authors.lastname: Battistoni
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: D'Angeli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Galluccio
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography