(18)F-FDG uptake predicts diagnostic yield of transbronchial biopsy in peripheral lung cancer.
OBJECTIVE
Recent advances in endobronchial ultrasonography with a guide sheath (EBUS-GS) have enabled better visualization of distal airways, while virtual bronchoscopic navigation (VBN) has been shown useful as a guide to navigate the bronchoscope. However, indications for utilizing VBN and EBUS-GS are not always clear. To clarify indications for a bronchoscopic examination using VBN and EBUS-GS, we evaluated factors that predict the diagnostic yield of a transbronchial biopsy (TBB) procedure for peripheral lung cancer (PLC) lesions.


METHODS
We retrospectively reviewed the charts of 194 patients with 201 PLC lesions (≤3cm mean diameter), and analyzed the association of diagnostic yield of TBB with [(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) positron emission tomography and chest computed tomography (CT) findings.


RESULTS
The diagnostic yield of TBB using VBN and EBUS-GS was 66.7%. High maximum standardized uptake value (SUVmax), positive bronchus sign, and ground-glass opacity component shown on CT were all significant predictors of diagnostic yield, while multivariate analysis showed only high (18)F-FDG uptake (SUVmax ≥2.8) and positive bronchus sign as significant predictors. Diagnostic yield was higher for PLC lesions with high (18)F-FDG uptake (SUVmax ≥2.8) and positive bronchus sign (84.6%) than for those with SUVmax <2.8 and negative bronchus sign (33.3%). High (18)F-FDG uptake was also correlated with tumor invasiveness.


CONCLUSIONS
High (18)F-FDG uptake predicted the diagnostic yield of TBB using VBN and EBUS-GS for PLC lesions. (18)F-FDG uptake and bronchus sign may indicate for the accurate application of bronchoscopy with those modalities for diagnosing PLC.
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan. Electronic address: umeda@u-fukui.ac.jp.
Yukihiro
Y
Umeda
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan.
Yoshiki
Y
Demura
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Masaki
M
Anzai
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan.
Hiroki
H
Matsuoka
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan.
Tomoyuki
T
Araya
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan.
Masaru
M
Nishitsuji
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa-shi, Ishikawa 920-8530, Japan.
Koichi
K
Nishi
Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Tatsuro
T
Tsuchida
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Yasuyuki
Y
Sumida
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Miwa
M
Morikawa
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Shingo
S
Ameshima
Fundamental Nursing Department, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Takeshi
T
Ishizaki
Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa-shi, Ishikawa 920-8641, Japan.
Kazuo
K
Kasahara
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan.
Tamotsu
T
Ishizuka
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D001706:Biopsy; D055745:Bronchioles / Q000473:pathology; D001999:Bronchoscopy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012189:Retrospective Studies
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Bronchoscopy; Endobronchial ultrasonography; Fluorodeoxyglucose; Lung cancer; Positron emission tomography; Transbronchial biopsy