Yayoi Tokoro1, Masanori Yasuo2, Takashi Kobayashi3, Mineyuki Hama4, Takashi Ichiyama5, Toshimichi Horiuchi6, Atsuhito Ushiki7, Satoshi Kawakami8, Takayuki Honda9, Masayuki Hanaoka10. 1. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: yanomura@shinshu-u.ac.jp. 2. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: yasumasa@shinshu-u.ac.jp. 3. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: takob@shinshu-u.ac.jp. 4. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: mineyuki@shinshu-u.ac.jp. 5. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: ichiyama@shinshu-u.ac.jp. 6. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: toshih@shinshu-u.ac.jp. 7. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: atsuhito@shinshu-u.ac.jp. 8. Department of Radiology, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: kawasato@shinshu-u.ac.jp. 9. Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: thondat@shinshu-u.ac.jp. 10. First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: masayuki@shinshu-u.ac.jp.
Abstract
BACKGROUND: Factors that affect the diagnostic yield in computed tomography (CT)-guided bronchoscopy have not yet been fully evaluated. To improve the diagnostic yield of peripheral pulmonary lesions (PPLs) by CT-guided bronchoscopy, we quantitatively analyzed factors affecting the diagnostic yield. METHODS: The data were collected for 240 PPLs in 237 patients examined by using CT-guided bronchoscopy between October 2003 and November 2011 in our respiratory center. The association of diagnostic yield with the CT bronchus sign (CT-BS), lesion size, location, number of tissue specimens, and type of bronchoscope was retrospectively assessed. RESULTS: The diagnostic yield of PPLs with negative CT-BS was significantly lower (2.9%) than that for PPLs with positive CT-BS (52.2%; p<0.01). Among the PPLs with positive CT-BS, the yield was significantly higher in those in the left S(3) than for lesions in other bronchial segments (83.3% vs. 50.3%; p<0.05). Lesion size was not significantly associated with diagnostic yield. The yield was significantly lower in PPLs without lung tissue specimens than in lesions with biopsy specimens (p<0.01). Moreover, a thin bronchoscope produced a higher yield in comparison with other bronchoscope types (66.0% vs. 47.6%; p<0.05). Multivariate analysis revealed that the number of biopsy specimens was an independent factor affecting diagnostic yield. CONCLUSIONS: CT-guided bronchoscopy is valuable in the diagnosis of PPLs with positive CT-BS regardless of lesion size; however, PPLs with negative CT-BS are not good candidates for CT-guided bronchoscopy. Obtaining tissue specimens by biopsy is a critical factor in diagnosing PPLs.
BACKGROUND: Factors that affect the diagnostic yield in computed tomography (CT)-guided bronchoscopy have not yet been fully evaluated. To improve the diagnostic yield of peripheral pulmonary lesions (PPLs) by CT-guided bronchoscopy, we quantitatively analyzed factors affecting the diagnostic yield. METHODS: The data were collected for 240 PPLs in 237 patients examined by using CT-guided bronchoscopy between October 2003 and November 2011 in our respiratory center. The association of diagnostic yield with the CT bronchus sign (CT-BS), lesion size, location, number of tissue specimens, and type of bronchoscope was retrospectively assessed. RESULTS: The diagnostic yield of PPLs with negative CT-BS was significantly lower (2.9%) than that for PPLs with positive CT-BS (52.2%; p<0.01). Among the PPLs with positive CT-BS, the yield was significantly higher in those in the left S(3) than for lesions in other bronchial segments (83.3% vs. 50.3%; p<0.05). Lesion size was not significantly associated with diagnostic yield. The yield was significantly lower in PPLs without lung tissue specimens than in lesions with biopsy specimens (p<0.01). Moreover, a thin bronchoscope produced a higher yield in comparison with other bronchoscope types (66.0% vs. 47.6%; p<0.05). Multivariate analysis revealed that the number of biopsy specimens was an independent factor affecting diagnostic yield. CONCLUSIONS: CT-guided bronchoscopy is valuable in the diagnosis of PPLs with positive CT-BS regardless of lesion size; however, PPLs with negative CT-BS are not good candidates for CT-guided bronchoscopy. Obtaining tissue specimens by biopsy is a critical factor in diagnosing PPLs.
Authors: Yeon Wook Kim; Hyung-Jun Kim; Myung Jin Song; Byoung Soo Kwon; Sung Yoon Lim; Yeon Joo Lee; Jong Sun Park; Young-Jae Cho; Ho Il Yoon; Jae Ho Lee; Choon-Taek Lee Journal: Transl Lung Cancer Res Date: 2022-03