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Observational Study
. 2025 Jan-Dec:19:17534666251357699.
doi: 10.1177/17534666251357699. Epub 2025 Aug 1.

Optimizing diagnostic yield in pulmonary lesions: impact of combined sampling tools and EBUS-TBNA during radial EBUS

Eduardo Tuta-Quintero  1   2 , Luis F Giraldo-Cadavid  3   4 , Catalina Sanmiguel-Reyes  5 , Maria E Navia  5 , Ricardo Cardenas  1   2 , Alirio Bastidas  5 , Angelica Mora  5 , Nelson Páez-Espinel  6 , Lucía Viola  6 , Miguel Suárez  6 , Libardo Jiménez-Maldonado  6 , Mauricio Durán  6 , Jacqueline Mugnier  7 , Javier Flandes  8
Affiliations
Observational Study

Optimizing diagnostic yield in pulmonary lesions: impact of combined sampling tools and EBUS-TBNA during radial EBUS

Eduardo Tuta-Quintero et al. Ther Adv Respir Dis. 2025 Jan-Dec.

Abstract

Background: Radial endobronchial ultrasound (r-EBUS) is a minimally invasive procedure used to evaluate pulmonary lesions suspicious of cancer. Current information on the effect of combining different sampling tools used during r-EBUS or the addition of linear EBUS (EBUS-TBNA) on its diagnostic performance is limited.

Objectives: To evaluate the effect on diagnostic performance of the systematic addition of different sampling tools and EBUS-TBNA during r-EBUS, as well as the rate of peri-procedural complications.

Design: This was an observational, analytical cohort study designed to evaluate diagnostic accuracy.

Methods: We calculated diagnostic accuracy statistics and used the Cochran-Armitage statistical test to assess the effect of combining techniques on diagnostic performance. Diagnostic success (DS) was defined as true positives and true negatives, while diagnostic failure was defined as false positives and false negatives.

Results: A total of 309 patients were included, with a mean age of 67.9 years (standard deviation: 10.97); 50.8% (157/309) were male. The bronchial washing had a DS rate of 49%, while bronchial brushing showed a DS rate of 61%. The combination of bronchial washing and bronchial brushing improved the r-EBUS performance to 63%. Combining bronchial washing, bronchial brushing, and transbronchial biopsy increased the performance to 70%, and the addition of EBUS-TBNA raised the diagnostic performance to 80% (p < 0.001; Cochran-Armitage test). The overall complication rate was 6.4% (20/309), with pneumothorax occurring in 1.2% (4/309), bronchospasm in 3.8% (12/309), and bleeding in 1.2% (4/309).

Conclusion: The use of multiple sampling tools significantly contributes to the DS of r-EBUS, particularly with the addition of EBUS-TBNA. This approach maintains a low complication rate.

Keywords: bronchoscopy; diagnostic techniques and procedures; lung neoplasms; sensitivity and specificity; ultrasonography.

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Figures

Procedure flow shows a diagram of EBUS procedures with different sampling techniques and steps.
Figure 1.
Procedure flow.
Hierarchical structure depicting patient flow during EBUS procedure with 1390 initial patients. TBNAs include other EBUS or EBUS & TBNAs, isolated from 191 and 309 patients respectively.
Figure 2.
Patient flow diagram.
Figure 3.
Figure 3.
Diagnostic performance of sampling tools used during Radial and Linear EBUS.
See this image and copyright information in PMC

References

    1. Choi HK, Mazzone PJ. Lung cancer screening. Med Clin North Am 2022; 106(6): 1041–1053. - PubMed
    1. Jonas DE, Reuland DS, Reddy SM, et al. Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2021; 325(10): 971–987. - PubMed
    1. Steinfort DP, Khor YH, Manser RL, et al. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011; 37(4): 902–910. - PubMed
    1. Gupta A, Youness H, Dhillon SS, et al. The value of using radial endobronchial ultrasound to guide transbronchial lung cryobiopsy. J Thorac Dis 2019; 11(1): 329–334. - PMC - PubMed
    1. Zarogoulidis P, Huang H, Chen W, et al. Radial endobronchial ultrasound for lung cancer diagnosis: tips and tricks. J Cancer 2022; 13(4): 1307–1312. - PMC - PubMed

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