Standard bronchoscopy with fluoroscopy versus thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: A multicenter, prospective, randomized trial.
- 2018
Available online from MWHC library: 1935 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: New technology has resulted in bronchoscopy being increasingly used for diagnosing pulmonary lesions. Reported yield from these procedures varies widely with few randomized clinical trials. This study compares the diagnostic yield of a thin bronchoscope and radial endobronchial ultrasound (R-EBUS) to standard bronchoscopy with fluoroscopy (SB-F) in lung lesions. CONCLUSIONS: Bronchoscopy with or without a thin scope and R-EBUS had a poor diagnostic yield for pulmonary lesions. Future work should focus on improvements in technique and technology advances that ensure a higher likelihood of obtaining a diagnosis. Copyright (c) 2018. Published by Elsevier Inc. METHODS: Patients presenting for diagnostic bronchoscopic evaluation at five centers were randomized to undergo SB-F or R-EBUS with thin bronchoscope (TB-EBUS). If SB-F was non-diagnostic, cross over to TB-EBUS arm was allowed. Patient demographics, radiographic features, and final pathologic or radiographic follow-up were collected. Statistical comparisons were made using Fisher square, chi-square tests and t-test. Bivariate and multivariate analyses were performed to determine predictors of diagnostic yield. RESULTS: A total of 197 patients were included in the final analyses. There was no difference in demographics, lesion size, or location between study arms. The average lesion size was 31.2mm (SD 10.8mm). Bronchoscopy was diagnostic in 44% (n=87) of cases. Although the diagnostic yield was higher in the TB-EBUS arm when compared to the SB-F arm (49% vs 37%), this difference was not statistically significant (p=0.11). Among those with non-diagnostic bronchoscopic findings in the standard arm, 87% (n=46) crossed over to TB-EBUS, resulting in a diagnosis in 7 (15% of 46) additional patients.