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Radial endobronchial ultrasound effectively identifies peripheral lung lesions
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Radial endobronchial ultrasound-guided bronchoscopy appeared useful for the diagnosis of peripheral lung lesions in a region with high incident tuberculosis, according to results of a retrospective study.
The diagnostic tool also identified tuberculosis lesions more rapidly, results showed.
Adrian Chan, MD, associate consultant in the department of respiratory and critical care medicine at Singapore General Hospital, and colleagues reviewed a database in Singapore General Hospital to analyze the utility of radial endobronchial ultrasound (EBUS) with guide sheath for the diagnosis of peripheral lung lesions (PLLs) in a high tuberculosis (TB) incidence setting.
The analysis included 120 patients who underwent bronchoscopy with radial EBUS guidance. Seventy-six participants had malignant PLLs and 44 participants had benign PLLs.
Radial EBUS for malignant tumors demonstrated a sensitivity of 65.8%, a positive predictive value of 100%, a negative predictive value of 62.9% and an overall diagnostic accuracy of 82.5%.
The diagnostic tool successfully diagnosed TB in 17 of 22 participants, with a positive predictive value of 100%, a negative predictive value of 95.1% and a diagnostic accuracy of 95.8%.
“In our population with a high incidence of pulmonary TB, it is important to review the clinical and radiologic characteristics of PLLS before deciding on choice of investigation for histologic diagnosis,” Chan and colleagues wrote. “Where clinical suspicion of malignancy is indeterminate or when pulmonary tuberculosis is suspected following initial negative sputum studies, radial EBUS is to be considered as a viable first step in the evaluation of PLLs. The additional yield, faster time to diagnosis and favorable safety profile of radial EBUS are the positive factors contributing to our recommendation.”
The results suggest radial EBUS may be a useful tool for the early diagnosis of TB, according to the researchers.
“Early diagnosis and appropriate treatment of infectious patients with pulmonary TB are important steps to reduce transmission of Mycobacterium tuberculosis and to achieve disease elimination,” the researchers wrote. “Radial EBUS aided in obtaining histological diagnosis consistent with pulmonary TB infection in 58.8% of our pulmonary TB patients, thus enabling pulmonologists to diagnose the disease and start anti-tuberculosis treatment earlier.” – by Ryan McDonald
Disclosure: The researchers report no relevant financial disclosures.
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