Dataset Information

The value of virtual bronchoscopic navigation and radial endobronchial ultrasound-guided transbronchial lung cryobiopsies for pulmonary lymphangitic carcinomatosis.

ABSTRACT:

Background

Pulmonary lymphangitic carcinomatosis (PLC) is characterized by malignant infiltration into lung lymphatic channels from a primary site and is often observed in advanced malignant tumors. This study aimed to evaluate the diagnostic yield of transbronchial lung cryobiopsy in PLC guided by radial endobronchial ultrasound and virtual bronchoscopic navigation (VBN).

Methods

This prospective study enrolled 40 patients with clinical and radiologic features indicating PLC. The radial endobronchial ultrasound probe was initially advanced to the region of interest of the desired lobe near the pleura with guidance by VBN. Transbronchial lung biopsy and transbronchial lung cryobiopsy were both performed in the same ROI of all patients with the obtained samples being sent to the pathology laboratory for diagnostic analysis. Procedural complications were recorded.

Results

The average number of transbronchial lung biopsy and transbronchial lung cryobiopsy specimens were 4 (3 to 6) and 2 (1 to 3), respectively (t=10.43, P<0.01), with the corresponding mean diameters per biopsy being 3.7 and 8.7 mm (t=12.37, P<0.01). The diagnostic yields of transbronchial lung biopsy and transbronchial lung cryobiopsy were 70% (28/40) and 92.5% (37/40), respectively. The final positive predictive values of transbronchial lung cryobiopsy and transbronchial lung biopsy for PLC were 94.4% (34/36) and 77.8% (28/36), respectively (χ²=23.94, P<0.01). Further, 52.2% (12/23) and 81.5% (22/27) of the patients in the transbronchial lung biopsy and transbronchial lung cryobiopsy groups, respectively, were diagnosed with non-small lung cancer after further molecular analysis (χ²=19.56, P<0.01). Only 2 (5%) cases presented postoperative pneumothorax. Moreover, 0 (0%), 3 (7.5%), and 17 (42.5%) patients presented severe, moderate, and mild bleeding, respectively. There were no other adverse events or deaths.

Conclusions

Transbronchial lung cryobiopsy with the guidance of radial endobronchial ultrasound and VBN without fluoroscopy has a good diagnostic yield for PLC; moreover, it allows one to obtain adequate and intact tissue samples for further molecular analysis.

SUBMITTER: Pang L

PROVIDER: S-EPMC7797829 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

The value of virtual bronchoscopic navigation and radial endobronchial ultrasound-guided transbronchial lung cryobiopsies for pulmonary lymphangitic carcinomatosis.

Pang Lingling L Jiang Tingshu T Liu Xueping X Li Zhan Z Zou Shenchun S Yu Pengfei P

Journal of thoracic disease 20201201 12

<h4>Background</h4>Pulmonary lymphangitic carcinomatosis (PLC) is characterized by malignant infiltration into lung lymphatic channels from a primary site and is often observed in advanced malignant tumors. This study aimed to evaluate the diagnostic yield of transbronchial lung cryobiopsy in PLC guided by radial endobronchial ultrasound and virtual bronchoscopic navigation (VBN).<h4>Methods</h4>This prospective study enrolled 40 patients with clinical and radiologic features indicating PLC. The ...[more]

PMID: 33447459

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Project description:BackgroundTransbronchial lung biopsy (TBLB) was a useful method for the diagnosis of peripheral pulmonary nodules (PPNs), but the smaller tissue samples obtained often could not meet the subsequent molecular pathological diagnosis. The purposes of this study were to assess the diagnostic yield of virtual bronchoscope navigation (VBN) combined with radial endobronchial ultrasound (rEBUS) guided transbronchial cryo-biopsy (TBCB) and to compare it with TBLB.MethodsPatients with PPNs, who planned to undergo bronchoscopy and were admitted to Henan Provincial People's Hospital and Zhoukou Central Hospital from January 1, 2020 to December 31, 2020, were divided into the TBCB group (experimental group) and TBLB group (control group) using the block randomization method. TBCB and TBLB were performed with the guidance of VBN-rEBUS. The diagnostic yields, complications, specimen surface areas, and operation times were observed. The differences between the two groups were measured by the independent sample t-test or Chi-square test.ResultsA total of 152 patients were enrolled, of whom 138 completed the study, and 102 received a definite diagnosis by bronchoscopy. The diagnostic yield showed no statistically significant difference between TBCB group and TBLB group (79.1% vs. 69.0%, P=0.124). For PPNs with the diameter <2 cm, TBCB group had a significantly higher diagnostic yield than TBLB group (76.5% vs. 50.0%, P=0.022); For PPNs with eccentric and adjacent radial ultrasonic images, TBCB group also had a significantly higher diagnostic yield than TBLB group (78.1% vs. 55.9%, P=0.023). The specimen surface area of TBCB group was larger than that of TBLB group (P=0.030). The incidence of moderate bleeding in TBCB group was higher than that in TBLB group (P=0.006), but no serious complications were observed in either group.ConclusionsAlthough the incidence rate of moderate bleeding was higher than that of TBLB, VBN-rEBUS guided TBCB is still a safe and effective diagnostic method for PPNs, and is superior to TBLB for PPNs with a diameter <2 cm or with an eccentric and adjacent radial ultrasonic image.Trial registrationChinese Clinical Trial Registry ChiCTR2100054949.

Project description:BackgroundRadial probe endobronchial ultrasound (radial EBUS) is widely used to diagnose pulmonary lesions; however, the diagnostic value of radial EBUS-guided transbronchial biopsy (TBB) varies, and its complications (especially the risk of bleeding) are not properly understood.ObjectivesIn this study, we evaluated the diagnostic performance and rate of complication of this procedure, and investigated the risk factors associated with the procedure-related bleeding events.DesignA retrospective cohort study.MethodsThis was a retrospective study that included consecutive patients who underwent radial EBUS-guided TBB. Radial EBUS was performed under moderate sedation in inpatients or outpatients. The severity of bleeding was graded using the standardized definitions of bleeding.ResultsOf 133 patients (median age, 69 years; men 57.1%) included, 41 were outpatients (30.8%). The diagnostic accuracy, sensitivity, and specificity for malignancy were 76.1% (89/117), 71.1% (69/97), and 100% (20/20), respectively. The diagnostic accuracy ranged from 66.9% to 79.0%, depending on the classification of undiagnosed cases as either false negatives or true negatives. Twenty-seven patients (20.3%) developed complications (pneumothorax, 3; pneumonia, 5; complicated pleural effusion, 2; bleeding event grade 2 or higher, 21). Of the 41 outpatients, two developed complications (pneumothorax without intervention, 1; grade 2 bleeding event, 1). Of the 21 patients (15.8%) with procedure-related bleeding events, 18 had grade 2, and three had grade 3 bleeding complications. In multivariate analysis, a large size of ⩾30 mm (adjusted odds ratio (OR), 5.09; p = 0.03) and central lesion (adjusted OR, 3.67; p = 0.03) were significantly associated with the risk of grade 2 or higher bleeding events.ConclusionOur results suggest that radial EBUS-guided TBB is an accurate and safe method for diagnosing pulmonary lesions. Clinically significant procedure-related bleeding was rare. The central location and larger size (⩾30 mm) of pulmonary lesions were risk factors for grade 2 or higher bleeding events.

Dataset Information

The value of virtual bronchoscopic navigation and radial endobronchial ultrasound-guided transbronchial lung cryobiopsies for pulmonary lymphangitic carcinomatosis.

Background

Methods

Results

Conclusions

Publications

The value of virtual bronchoscopic navigation and radial endobronchial ultrasound-guided transbronchial lung cryobiopsies for pulmonary lymphangitic carcinomatosis.

Similar Datasets

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