Nichole T Tanner1, Lonny Yarmus2, Alexander Chen3, Jessica Wang Memoli4, Hiren J Mehta5, Nicholas J Pastis6, Hans Lee2, Michael A Jantz5, Paul J Nietert7, Gerard A Silvestri6. 1. Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC. Electronic address: tripici@musc.edu. 2. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. 3. Division of Pulmonary and Critical Care, Washington University School of Medicine, St. Louis, MO. 4. Division of Pulmonary, Critical Care and Respiratory Services, Medstar Washington Hospital Center, Washington, DC. 5. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL. 6. Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC. 7. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
Abstract
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) with standard bronchoscopy and fluoroscopy (SB-F) in lung lesions. METHODS:Patients presenting for diagnostic bronchoscopic evaluation at five centers were randomized to undergo SB-F or R-EBUS with a thin bronchoscope (TB-EBUS). If SB-F was nondiagnostic, crossover to the TB-EBUS arm was allowed. Data on patient demographics, radiographic features, and final pathologic or radiographic follow-up were collected. Statistical comparisons were made by Fisher exact test, χ2 test, and Student t test. Bivariate and multivariate analyses were performed to determine predictors of diagnostic yield. RESULTS:One hundred and ninety-seven 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 31.2 mm (SD, 10.8 mm). Bronchoscopy was diagnostic in 87 patients (44%). Although the diagnostic yield was higher in the TB-EBUS arm compared with the SB-F arm (49% vs 37%), this difference was not statistically significant (P = .11). Among those with nondiagnostic bronchoscopic findings in the standard arm, 87% (n = 46) crossed over to TB-EBUS, resulting in a diagnosis in seven additional patients (15% of 46). 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. Published by Elsevier Inc.
RCT Entities:
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) with standard bronchoscopy and fluoroscopy (SB-F) in lung lesions. METHODS:Patients presenting for diagnostic bronchoscopic evaluation at five centers were randomized to undergo SB-F or R-EBUS with a thin bronchoscope (TB-EBUS). If SB-F was nondiagnostic, crossover to the TB-EBUS arm was allowed. Data on patient demographics, radiographic features, and final pathologic or radiographic follow-up were collected. Statistical comparisons were made by Fisher exact test, χ2 test, and Student t test. Bivariate and multivariate analyses were performed to determine predictors of diagnostic yield. RESULTS: One hundred and ninety-seven 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 31.2 mm (SD, 10.8 mm). Bronchoscopy was diagnostic in 87 patients (44%). Although the diagnostic yield was higher in the TB-EBUS arm compared with the SB-F arm (49% vs 37%), this difference was not statistically significant (P = .11). Among those with nondiagnostic bronchoscopic findings in the standard arm, 87% (n = 46) crossed over to TB-EBUS, resulting in a diagnosis in seven additional patients (15% of 46). 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. Published by Elsevier Inc.
Authors: Michael K Gould; Tania Tang; In-Lu Amy Liu; Janet Lee; Chengyi Zheng; Kim N Danforth; Anne E Kosco; Jamie L Di Fiore; David E Suh Journal: Am J Respir Crit Care Med Date: 2015-11-15 Impact factor: 21.405
Authors: Gerard A Silvestri; Anil Vachani; Duncan Whitney; Michael Elashoff; Kate Porta Smith; J Scott Ferguson; Ed Parsons; Nandita Mitra; Jerome Brody; Marc E Lenburg; Avrum Spira Journal: N Engl J Med Date: 2015-05-17 Impact factor: 91.245
Authors: David E Ost; Armin Ernst; Xiudong Lei; Kevin L Kovitz; Sadia Benzaquen; Javier Diaz-Mendoza; Sara Greenhill; Jennifer Toth; David Feller-Kopman; Jonathan Puchalski; Daniel Baram; Raj Karunakara; Carlos A Jimenez; Joshua J Filner; Rodolfo C Morice; George A Eapen; Gaetane C Michaud; Rosa M Estrada-Y-Martin; Samaan Rafeq; Horiana B Grosu; Cynthia Ray; Christopher R Gilbert; Lonny B Yarmus; Michael Simoff Journal: Am J Respir Crit Care Med Date: 2016-01-01 Impact factor: 21.405
Authors: Lonny B Yarmus; Christopher Mallow; Nicholas Pastis; Jeffrey Thiboutot; Hans Lee; David Feller-Kopman; Andrew D Lerner; Nicole Tanner; Gerard Silvestri; Alexander Chen Journal: Respiration Date: 2019-11-08 Impact factor: 3.580
Authors: Alexander C Chen; Nicholas J Pastis; Michael S Machuzak; Thomas R Gildea; Michael J Simoff; Colin T Gillespie; Amit K Mahajan; Scott S Oh; Gerard A Silvestri Journal: Respiration Date: 2019-12-05 Impact factor: 3.580
Authors: Ala-Eddin S Sagar; Bruce F Sabath; George A Eapen; Juhee Song; Mathieu Marcoux; Mona Sarkiss; Muhammad H Arain; Horiana B Grosu; David E Ost; Carlos A Jimenez; Roberto F Casal Journal: Chest Date: 2020-06-17 Impact factor: 9.410
Authors: Roberto F Casal; Mona Sarkiss; Aaron K Jones; John Stewart; Alda Tam; Horiana B Grosu; David E Ost; Carlos A Jimenez; George A Eapen Journal: J Thorac Dis Date: 2018-12 Impact factor: 2.895
Authors: Lonny Yarmus; Jason Akulian; Momen Wahidi; Alex Chen; Jennifer P Steltz; Sam L Solomon; Diana Yu; Fabien Maldonado; Jose Cardenas-Garcia; Daniela Molena; Hans Lee; Anil Vachani Journal: Chest Date: 2019-11-01 Impact factor: 9.410
Authors: Or Kalchiem-Dekel; James G Connolly; I-Hsin Lin; Bryan C Husta; Prasad S Adusumilli; Jason A Beattie; Darren J Buonocore; Joseph Dycoco; Paige Fuentes; David R Jones; Robert P Lee; Bernard J Park; Gaetano Rocco; Mohit Chawla; Matthew J Bott Journal: Chest Date: 2021-08-09 Impact factor: 9.410