Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial.
BACKGROUND
The evaluation of solitary pulmonary lesions (SPL) requires a balance between procedure-related morbidity and diagnostic yield, particularly in areas where tuberculosis (TB) is endemic. Data on ultrathin bronchoscopy (UB) for this purpose is limited. To evaluate feasibility and safety of UB compared to SB for diagnosis of SPL in a TB endemic region.


METHODS
In this prospective randomised trial we compared diagnostic yield and adverse events of UB with standard-size bronchoscopy (SB), both combined with fluoroscopy, in a cohort of patients with SPL located beyond the visible range of SB.


RESULTS
We included 40 patients (mean age 55.2 years, 45 % male) with malignant SPL (n = 16; 40 %), tuberculous SPL (n = 11; 27.5 %) and other benign SPL (n = 13; 32.5 %). Mean procedure time in UB and SB was 30.6 and 26.0 min, respectively (p = 0.15). By trend, adverse events were recorded more often with UB than with SB (30.0 vs. 5.0 %, p = 0.091), including extensive coughing (n = 2), blocked working channel (n = 2), and arterial hypertension requiring therapeutic intervention (n = 1), all with UB. The overall diagnostic yield of UB compared to SB was 55.0 % vs. 80.0 %, respectively (p = 0.18). Sensitivity for the diagnosis of malignancy of UB and SB was 50.0 % and 62.5 %, respectively (p = 0.95).


CONCLUSIONS
UB is not superior to SB for the evaluation of SPL in a region endemic with tuberculosis, when combined with fluoroscopic guidance only.


BACKGROUND
ClinicalTrials.gov (Identifier: NCT02490059 ).
Division of Pulmonology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
Daniel
D
Franzen
Department of Internal Medicine, Lung Unit, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
Andreas H
AH
Diacon
Division of Pulmonology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
Lutz
L
Freitag
Division of Anatomical Pathology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.|NHLS, Port Elizabeth and Tygerberg Hospital, Cape Town, South Africa.
Pawel T
PT
Schubert
Division of Anatomical Pathology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.|NHLS, Port Elizabeth and Tygerberg Hospital, Cape Town, South Africa.
Colleen A
CA
Wright
Division of Pulmonology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland. mace.schuurmans@usz.ch.|Department of Internal Medicine, Lung Unit, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa. mace.schuurmans@usz.ch.
Macé M
MM
Schuurmans
D001706:Biopsy / Q000379:methods; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000295:instrumentation*; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D010865:Pilot Projects; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*
Diagnostic yield; Histology; Lung cancer; Solitary pulmonary nodule; Ultrathin bronchoscopy