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Intern Med J. 2008 Feb;38(2):77-84. Epub 2007 Oct 3.

Biopsy site selection for endobronchial ultrasound guide-sheath transbronchial biopsy of peripheral lung lesions.

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1
Department of Thoracic Medicine, Royal Brisbane and Womens' Hospital, Brisbane, Queensland, Australia. david_fielding@health.qld.gov.au

Abstract

BACKGROUND:

Choice of biopsy method for peripheral lung lesions is usually between CT-guided fine-needle aspiration biopsy (CT FNA) and bronchoscopy. Endobronchial ultrasound guide-sheath biopsy (EBUS GS) is a new method to improve the yield of bronchoscopy. Guidance on which lesions would be appropriate for either method is needed. The aim of the study was to compare the diagnostic yields and pneumothorax rate of EBUS GS and CT FNA in terms of the location of the lesion needing biopsy, in particular, whether the lesion is touching the pleura.

METHODS:

Prospective series of EBUS GS were compared to retrospective review of CT FNA carried out simultaneously in a large teaching hospital.

RESULTS:

For EBUS GS 140 cases were carried out with mean lesion size 29 mm. Overall diagnostic sensitivity was 66%. For lesions not touching visceral pleura it was 74% compared with 35% where it was on the pleura (P < 0.01). For CT FNA 121 cases were carried out with mean lesion size 37 mm. The overall diagnostic sensitivity was 64%. Rate of pneumothorax and ICC placement in EBUS GS was 1 and 0% and in CTFNA was 28 and 6%, with P < 0.001 for both.

CONCLUSION:

Lesion location, in particular, connection to the visceral pleura, can improve decision-making in referral for either CT FNA or EBUS GS to maximize diagnostic yield and minimize pneumothorax rate.

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