Diagnostic value of endobronchial ultrasound-guided transbronchial lung biopsy in peripheral lung cancers

Background and Purpose: The diagnostic yield of flexibel fiberoptic bronchoscopy for peripheral lung cancers is still limited. This study evaluated whether endobronchial ultrasound (EBUS) may help localized and improve the diagnostic yield of bronchoscopic transbrochial lung biopsy in peripheral lung cancer. Methods: Between July 2001 and May 2002, 218 patient received transbrochial lung biopsy during bronchoscopic examinations with (n = 122) or without EBUS guidance (n = 96) and had the presence of peripheral lung cancers subsequently confirmed. These 218 patients were included in this retrospective analysis. Results: The diagnostic accuracy of transbrochial lung biopsy was significantly increased under EBUS guidance for small cell carcinoma (65.6%) and for non-small cell carcinoma (42.7%) [p <0.01]. For peripheral lung cancer either smaller than 2 cm or larger than 2 cm, the diagnostic yield of transbronchial lung biopsy with EBUS guidance was significantly higher (66.0% vs 42.3%, p <0.0002 for mass larger than 2 cm; 54.5% vs 0%, p <0.04 for mass smaller than 2 cm). EBUS provided a better diagnostic yield (p=0.014; odds ratio, 0.219) for lesions localized at the left upper lobe, which are generally thought to be more difficult to a approach through bronchoscopy. There were no significant differences in complications between patients who underwent bronchoscopy with or without EBUS guidance. Conclusions: Under EBUS guidance, the diagnostic yield of transbrochial lung biopsy in peripheral lung cancer by bronchoscopic examination was significantly improved without difference in the complication rate.