A Randomized Controlled Trial on Optimal Sampling Sequence in Radial Guide Sheath Endobronchial Ultrasound Lung...

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Imaging

Background:

• Optimal sampling sequence for radial probe endobronchial ultrasound (R-EBUS) lung biopsy remains unclear.
• This study investigated the impact of sampling order on R-EBUS diagnostic accuracy.

Purpose of the Study:

• To determine if the initial method and sequence of sampling affect the diagnostic accuracy of R-EBUS lung biopsy.
• To compare diagnostic yields across different sampling strategies in R-EBUS procedures.

Main Methods:

• Prospective, single-center pilot randomized controlled trial.
• Patients with lesions >15 mm and a bronchus sign were randomized (1:1:1) to biopsy-first (A), brushings-first (B), or combination (C) sampling sequences.
• Primary outcome was a positive diagnosis from any sampling method.

Main Results:

• Overall diagnostic yield was 77.8% with no significant difference between groups.
• Biopsies performed before brushings/washings (Group A) showed higher positive cytology rates for both brushings and washings.
• All three sampling modalities were more likely to be positive in Group A compared to other groups (P=0.04).
• Complication rates were low and similar across groups.

Conclusions:

• The initial sampling method or sequence in R-EBUS does not influence the overall diagnostic rate.
• Performing biopsies first, followed by brushings and washings, maximizes the positivity of all sampling modalities.
• This sequence may enhance the diagnostic yield from individual sampling techniques within R-EBUS.