Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy

Background : Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. We investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs. Methods We retrospectively reviewed data from 537 patients who underwent RP-EBUS-TBLB of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS and without fluoroscopy. The diagnostic yield and complications were assessed. All lung lesions without a definitive diagnosis were excluded from analyses. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields. Results The overall diagnostic accuracy, sensitivity, specificity, positive predictive, and negative predictive values were 93.0% (462/497), 89.7% (305/340), 100% (157/157), 100% (305/305), and 81.8% (157/192), respectively. In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.20; 95% confidence interval [CI], 1.03-4.72; p = 0.043) and having the probe within the lesion (OR, 3.08; 95% CI, 1.47-6.44; p = 0.003) were associated with diagnostic success. Pneumothorax occurred in 2.2% (12/537) of cases and chest tube insertion was required in 0.6% (3/537) of patients. Conclusions When diagnosing PPLs, RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method that does not cause exposure to radiation with acceptable complication rates. Lesions ≥ 20 mm and having the probe within the lesion improve diagnostic success.