Randomised trial of assessing diagnostic yield in transbronchial biopsy with a guide sheath

Abstract

Objectives: Radial probe endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) with a guide sheath (GS) is widely used to diagnose peripheral lung lesions (PPLs), but there is no consensus on whether it increases the diagnostic yield. We conducted this prospective study to compare the diagnostic yield of the GS method to the conventional method without a GS.

Methods: From November 2019 to March 2023, patients with PPLs were recruited and randomly assigned to rEBUS-TBB with a GS (GS group) or without a GS (conventional group). The histopathology, cytology and microbiology yield rates, as well as procedure time and post-procedure adverse events, of the two groups were compared.

Results: A total of 102 patients were enrolled (54 in the GS group and 48 in the conventional group). The pathology yield showed no statistical difference between the two groups (75.9% versus 68.8%, p=0.418), while the yield rates of brushing cytology (64.3% versus 42.9%, p=0.030) and washing cytology (41.5% versus 20.0%, p=0.0443) were higher in the GS group. Meanwhile, the yield from GS washing culture was lower than the bronchial washing culture yield (0% versus 57.1%, p=0.017). The bleeding risk was also lower in the GS group (9.3% versus 20.8%, p=0.049).

Conclusion: The pathology yield of rEBUS TBB with a GS did not significantly differ from the conventional method. However, a GS could improve the cytology yield rate and reduce the risk of bleeding. To enhance the microbiology yield, additional bronchial washing should be utilised.