Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy in Peripheral Pulmonary Lesions

Objective: Endobronchial ultrasound (EBUS) has emerged as a new diagnostic tool that allows bronchoscopists to see beyond the airway. The radial-type miniature probe can localize peripheral pulmonary lesions (PPLs) prior to transbronchial biopsy (TBB). The purpose of this retrospective study was to evaluate the factors affecting the diagnostic yield of lung lesions using EBUS-guided bronchoscopic examinations performed by highly experienced bronchoscopists.Methods: From 2009 to 2010, 144 patients with pulmonary lesions that were beyond the segmental bronchus received EBUS examinations at E-DA Hospital. Their medical records were reviewed and analyzed retrospectively.Results: Pulmonary lesions were found in 120 patients (83.3%) using EBUS. Lesion size was a determining factor for the visibility of the PPLs. A definitive diagnosis was established in 114 of the 120 patients. The diagnostic rate of EBUS-TBB in EBUS-visible lesions was 82.4% (94/114). The overall diagnostic yield of EBUS-guided bronchial examinations was 65.3% (94/144). Binary logistic regression analysis revealed that a lesion size larger than 3 cm, the probe within the lesion, and the lesion located in the left upper lobe relative to the right lower lobe were independent predictors of diagnostic yield (p=0.029, 0.029 and 0.036, respectively). Conclusions: Lesion size is a significant factor influencing the visibility of PLLs. The lesion size, the probe position and the lesion location (left upper lobe relative to the right lower lobe) were independent predictors of diagnostic yield by EBUS-guided bronchoscopic examination.