Diagnostic utility of bronchoscopy for newly emerging peripheral pulmonary lesions after pulmonary resection

Accurate diagnosis of newly emerging peripheral pulmonary lesions (PPLs) after pulmonary resection for malignancies is essential for a favorable prognosis. We aimed to investigate the diagnostic utility and safety of bronchoscopy for PPLs after pulmonary resection of malignant tumors and to evaluate the effect of prior surgery on the diagnostic performance.

As a single-center retrospective study, consecutive patients who underwent radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy under X-ray fluoroscopic support for PPLs that developed after pulmonary resection of malignancies at National Cancer Center Hospital, Tokyo, Japan between January 2017 and December 2022 were analyzed. Because surgery was considered to influence the architecture of the ipsilateral peripheral bronchi, the diagnostic results were compared between the groups of patients after ipsilateral and contralateral pulmonary resections.

In total, 220 patients, 110 each in the ipsilateral and contralateral biopsy groups were analyzed. The overall number of diagnostic cases was 158 of 220 (71.8%), and the diagnostic yield was significantly lower in the ipsilateral biopsy group than in the contralateral biopsy group (62.7% vs. 80.9%, P=0.004). According to the lobe-specific comparisons, the middle lobe/lingula showed a significant difference in diagnostic yield between the ipsilateral and contralateral biopsy groups (45.8% vs. 85.7%, P=0.02). In multivariable analysis, in addition to the negative bronchus sign, not visible on radiography, and the lesion lobe (others against the right upper lobe/left upper segment), the ipsilateral biopsy group was significantly associated with a lower diagnostic yield (adjusted odds ratio, 0.41; 95% confidence interval: 0.21-0.79; P=0.008). A total of seven patients (3.2%) experienced some complications, none of which were life-threatening.

Bronchoscopy had a sufficient diagnostic yield and safety for PPLs after pulmonary resection of malignancies. However, the diagnostic performance was reduced in biopsies ipsilateral to prior resections.