Diagnostic Yields of Bronchoscopy Techniques in Pulmonary Lesions

When diagnosing pulmonary lesions, bronchoscopy and radial endobronchial ultrasound, with or without a thin scope, produced a poor diagnostic yield for clinicians, according to a study published in CHEST.

Although bronchoscopy is increasingly used to diagnose pulmonary lesions, the reported diagnostic yield for these procedures in the few existing clinical trials varies widely. From July 2014 to April 2017, researchers randomly assigned 221 patients at 5 centers to treatment groups via computer to assess the diagnostic yield of bronchoscopy with a thin scope and radial endobronchial ultrasound (n=113) vs the standard bronchoscopy with fluoroscopy (n=108). If the standard bronchoscopy with fluoroscopy was not diagnostic, patients were allowed to cross over into the thin scope bronchoscopy and radial endobronchial ultrasound arm.

There was no difference in location, lesion size, or demographics between arms, with an average 31.2 mm (SD 10.8 mm) lesion size. Ultimately, 197 patients were included for analysis, with 85 in the standard bronchoscopy arm, and 112 in the thin bronchoscopy arm.

For 87 of 197 patients (44%), bronchoscopy was diagnostic, with a higher diagnostic yield in patients receiving thin scope bronchoscopy with radial endobronchial ultrasound vs standard bronchoscopy with fluoroscopy, although the difference observed was not statistically significant (P =.11). A total of 87% of patients with nondiagnostic standard bronchoscopies (n=46) crossed over to the thin scope bronchoscopy with radial endobronchial ultrasound arm, which resulted in 7 more patients (15% of the 46) receiving a diagnosis.

The investigators concluded that in this treatment setting, “bronchoscopy with or without a thin scope and [radial endobronchial ultrasound] had a poor diagnostic yield for pulmonary lesions. Future work should focus on improvements in technique and advances in technology that ensure a higher likelihood of obtaining a tissue diagnosis.” 

Disclosures: This trial was funded by Olympus America, which had no role in the trial design or manuscript preparation.

Reference

Tanner NT, Yarmus L, Chen A, et al. Standard bronchoscopy with fluoroscopy versus thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: a multicenter, prospective, randomized trial [published online August 22, 2018]. CHEST. doi:10.1016/j.chest.2018.08.1026