Diagnosis of peripheral lung lesions by EBUS-guided TBB in routine practice

To determine the diagnostic yield of EBUS guided TBB performed in routine practice with flexible bronchoscopy and under moderate sedation in ambulatory and hospitalized patients.

Bronchoscopy was performed under standard conditions in ambulatory and hospitalised patients. Bronchoscopically invisible peripheral pulmonary lesions were located with 20 MHZ-EBUS-probe and transbronchial biopsy was taken using a guiding sheath. Fluoroscopy was additionally performed as required to identify the lesion.

257 patients with peripheral pulmonal lesions were investigated, with malignancy in 70% of those with a diagnosis established. 175/257 (68.1%) of lesions were detected with EBUS. In 139/176 (79.4%) of these lesions, TBB enabled a final diagnosis. The TBB yield depended on lesion size. It was 61.3% in lesions ≤20 mm, 85.5% >20 mm/≤30 mm, and 81.2% in ≥30 mm (p<0.0001). This yield was also affected by the position of the probe (centrally 84.5%, tangentially 57.6%, p=0.01)). Operator experience did not influence the diagnostic yield but considerably shortened investigation time (4.9±3.5 vs. 6.2±4.2 min, p=0.042). Relevant complications occurred in only 1.9% (3 cases of postinterventional pneumothorax).

In an unselected population, EBUS-guided TBB has a high diagnostic yield in peripheral lesions >20 mm whereas its yield decreases considerably in smaller lesions. Complications are very rare. EBUS-guided TBB can successfully and safely be performed by flexible bronchoscopy.