J Cancer 2019; 10(3):634-642. doi:10.7150/jca.28755

Research Paper

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Zhiang Huang1,2#, Haidong Huang1✉, Yunye Ning1#, Jin Han1,3#, Yibo Shen1,4#, Hui Shi1#, Qin Wang1#, Chong Bai1, Qiang Li5, Simoff Michael6, Paul Zarogoulidis7✉, Wolfgang Hohenforst-Schmidt8, Fotis Konstantinou9, J. Francis Turner10, Charilaos Koulouris11, Athanasios Katsaounis11, Aikaterini Amaniti, Stylianos Mantalovas11, Efstathios Pavlidis11, Dimitrios Giannakidis11, Ioannis Passos11, Nikolaos Michalopoulos11, Christoforos Kosmidis11, Stelian Ştefăniţă Mogoantă12, Konstantinos Sapalidis11

1. Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China
2. Department of Respiratory, The First Affiliated Hospital of Henan University, Henan Kaifeng, 475000, China
3. Department of Respiratory Medicine, The Hospital of Yantaishan, Shandong Yantai, 264000, China
4. Department of Respiratory Medicine, The Fourth People's Hospital of Zigong, Sichuan Zigong, 643000, China
5. The Diagnostic and Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
6. Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan.Detroit,USA
7. Pulmonary Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
8. Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany
9. Thoracic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
10. University of Tennessee Graduate School of Medicine, Department of Medicine, Knoxville, TN, USA
11. 3rd Surgery Department, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
12. Department of Surgery, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Craiova, Romania
# Zhiang Huang, Yunye Ning, Jin Han, Yibo Shen, Hui Shi and Qin Wang contributed equally to this work.

Abstract

Background: The diagnosis of peribronchial pulmonary lesions located in the tertiary bronchi, also known as segmental bronchi, as well as, the 4th order and 5th order segmental bronchi is very difficult. Histopathological specimens cannot be easily obtained by endobronchial biopsies (EBBX) due to the patent but small segmental bronchial lumen. The aim of the present study was to evaluate the diagnostic accuracy and safety of the novel technique with radial probe endobronchial ultrasound (R-EBUS) assisted conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of solitary peribronchial pulmonary lesions located in segmental bronchi from 3th to 5th order.

Methods: From December 2014 to December 2015, 16 patients with solitary peribronchial pulmonary lesions in the segmental bronchi from 3th to 5th order confirmed by computed tomography (CT) were enrolled. The lesions were located using radial probe endobronchial ultrasound (R-EBUS) to determine the sites of conventional transbronchial needle aspiration (C-TBNA), then, histopathological specimens were obtained using the technique of C-TBNA. The final pathological diagnosis was made based on the findings from the surgical specimens. Statistical analyses were performed for specimen results and complications.

Results: On pathological evaluation, 14 of the 16 specimens were malignant, including 8 adenocarcinomas, 4 squamous cell carcinomas, and 2 small cell carcinomas, while 2 were non-malignant diseases. The diagnostic accuracy rate, sensitivity and missed diagnosis rates were 87.5%, 87.5% and 12.5%, respectively. When Combined the results of cytology with histologic samples obtained from C-TBNA the total diagnostic accuracy rate, sensitivity and missed diagnosis rate were 93.75%, 93.75% and 6.25%, respectively. There were 2 cases of bleeding complications >5 mL after C-TBNA, and both were resolved with endobronchial management.

Conclusions: The combination of R-EBUS with C-TBNA was advantageous and safe for the diagnosis of solitary peribronchial pulmonary lesions located in the segmental bronchi. However, possible bleeding complications should be anticipated with needle aspiration. Further verification of this combined application should be investigated in larger clinical trials.

Keywords: radial probe endobronchial ultrasound, conventional transbronchial needle aspiration, segmental bronchi, pulmonary lesions, bronchoscope, diagnosis

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How to cite this article:
Huang Z, Huang H, Ning Y, Han J, Shen Y, Shi H, Wang Q, Bai C, Li Q, Michael S, Zarogoulidis P, Hohenforst-Schmidt W, Konstantinou F, Turner JF, Koulouris C, Katsaounis A, Amaniti A, Mantalovas S, Pavlidis E, Giannakidis D, Passos I, Michalopoulos N, Kosmidis C, Mogoantă SŞ, Sapalidis K. Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi. J Cancer 2019; 10(3):634-642. doi:10.7150/jca.28755. Available from http://www.jcancer.org/v10p0634.htm