title: Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry.
abstract: BACKGROUND
  Advanced bronchoscopy techniques such as electromagnetic navigation (EMN) have been studied in clinical trials, but there are no randomized studies comparing EMN with standard bronchoscopy.
  
  
  OBJECTIVE
  To measure and identify the determinants of diagnostic yield for bronchoscopy in patients with peripheral lung lesions. Secondary outcomes included diagnostic yield of different sampling techniques, complications, and practice pattern variations.
  
  
  METHODS
  We used the AQuIRE (ACCP Quality Improvement Registry, Evaluation, and Education) registry to conduct a multicenter study of consecutive patients who underwent transbronchial biopsy (TBBx) for evaluation of peripheral lesions.
  
  
  RESULTS
  Fifteen centers with 22 physicians enrolled 581 patients. Of the 581 patients, 312 (53.7%) had a diagnostic bronchoscopy. Unadjusted for other factors, the diagnostic yield was 63.7% when no radial endobronchial ultrasound (r-EBUS) and no EMN were used, 57.0% with r-EBUS alone, 38.5% with EMN alone, and 47.1% with EMN combined with r-EBUS. In multivariate analysis, peripheral transbronchial needle aspiration (TBNA), larger lesion size, nonupper lobe location, and tobacco use were associated with increased diagnostic yield, whereas EMN was associated with lower diagnostic yield. Peripheral TBNA was used in 16.4% of cases. TBNA was diagnostic, whereas TBBx was nondiagnostic in 9.5% of cases in which both were performed. Complications occurred in 13 (2.2%) patients, and pneumothorax occurred in 10 (1.7%) patients. There were significant differences between centers and physicians in terms of case selection, sampling methods, and anesthesia. Medical center diagnostic yields ranged from 33 to 73% (P = 0.16).
  
  
  CONCLUSIONS
  Peripheral TBNA improved diagnostic yield for peripheral lesions but was underused. The diagnostic yields of EMN and r-EBUS were lower than expected, even after adjustment.
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
authors.affiliation: 2 Department of Pulmonary and Critical Care Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts.
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
authors.affiliation: 3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: 4 Chicago Chest Center, Chicago, Illinois.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kovitz
authors.affiliation: 5 University Hospital of Cincinnati Veteran Affairs Medical Center, Cincinnati, Ohio.
authors.forename: Sadia
authors.initials: S
authors.lastname: Benzaquen
authors.affiliation: 6 Henry Ford Hospital, Detroit, Michigan.
authors.forename: Javier
authors.initials: J
authors.lastname: Diaz-Mendoza
authors.affiliation: 6 Henry Ford Hospital, Detroit, Michigan.
authors.forename: Sara
authors.initials: S
authors.lastname: Greenhill
authors.affiliation: 7 Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Toth
authors.affiliation: 8 John Hopkins Hospital, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: 9 Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Puchalski
authors.affiliation: 10 Mather Memorial Hospital, Port Jefferson, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Baram
authors.affiliation: 11 Munroe Regional Medical Center, Ocala, Florida.
authors.forename: Raj
authors.initials: R
authors.lastname: Karunakara
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: 12 Kaiser Sunnyside Medical Center, Clackamas, Oregon; and.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Filner
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.affiliation: 9 Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Gaetane C
authors.initials: GC
authors.lastname: Michaud
authors.affiliation: 13 Lyndon B. Johnson Hospital-The University of Texas Health Science Center Houston, Houston, Texas.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Estrada-Y-Martin
authors.affiliation: 2 Department of Pulmonary and Critical Care Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts.
authors.forename: Samaan
authors.initials: S
authors.lastname: Rafeq
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.affiliation: 6 Henry Ford Hospital, Detroit, Michigan.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ray
authors.affiliation: 7 Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Gilbert
authors.affiliation: 8 John Hopkins Hospital, Baltimore, Maryland.
authors.forename: Lonny B
authors.initials: LB
authors.lastname: Yarmus
authors.affiliation: 6 Henry Ford Hospital, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Simoff
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data; D018893:Bronchoalveolar Lavage / Q000706:statistics & numerical data; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000175:diagnosis* / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology; D008297:Male; D011030:Pneumothorax / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: bronchoscopy; electromagnetic navigation; endobronchial ultrasound; lung cancer; transbronchial biopsy