Endobronchial ultrasound-guided transbronchial biopsy and brushing: a comparative evaluation for the diagnosis of peripheral pulmonary lesions.
OBJECTIVE
The diagnosis of peripheral pulmonary lesions (PPLs) often involves endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB), washing and brushing. Certain echoic features of PPL have been associated with biopsy yield. This study compared yields of TBB and bronchial washing (TBBW) with those of TBBW plus bronchial brushing and analysed the associations between clinical and echoic features and yield.


METHODS
We performed a retrospective review of 271 patients undergoing TBB for PPL. TBBW was performed in 139 patients and 132 underwent TBBW plus brushing.


RESULTS
The diagnostic yield of TBBW plus brushing was superior to that of TBBW (80.3 vs 66.2%, P < 0.01). In TBBW patients, lesions <3 cm (57.1 vs 73.7%, P < 0.05), EBUS probe adjacent to the lesion (47.6 vs 74.2%, P < 0.01), continuous margin (56.5 vs 75.7%, P < 0.01) and homogeneous echogenicity (51.0 vs 75.0%, P < 0.01) predicted lower yields, but adding bronchial brushing rendered the diagnostic yields similar, irrespective of EBUS echoic features, leaving lesion size of <3 cm (odds ratio 2.81; 95% confidence interval 1.08-7.31, P < 0.05) as the single independent predictor of lower yield by multivariate regression analysis. TBB plus brushing was not inferior to TBBW plus brushing (78.8 vs 80.3%, P = 0.88).


CONCLUSIONS
Bronchial brushing boosted diagnostic yields, particularly for PPLs with echoic features previously associated with a reduced biopsy yield.
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan.
Chih-Hsi
CH
Kuo
Shu-Min
SM
Lin
Kang-Yun
KY
Lee
Fu-Tsai
FT
Chung
Yu-Lun
YL
Lo
Te-Chih
TC
Hsiung
Chien-Ying
CY
Liu
Han-Pin
HP
Kuo
D000368:Aged; D001706:Biopsy / Q000379:methods; D001980:Bronchi / Q000000981:diagnostic imaging / Q000601:surgery; D001999:Bronchoscopy / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
Brushing; Endobronchial ultrasound; Peripheral pulmonary lesion; Transbronchial biopsy