PURPOSE: Endobronchial ultrasound (EBUS) has proven to be useful in the detection and sampling of peripheral consolidations and nodules that are echo dense. We assessed the usefulness of EBUS for the biopsy of interstitial infiltrates where the echo signals are more subtle.
METHODS: We analyzed the data from all EBUS guided transbronchial biospies over a 10 month period. Patients with radiographic findings of focal interstitial or inflammatory infiltrates that were detected and sampled using EBUS were included. Patients with nodular infiltrates, nodules, or consolidations were excluded. The histology results were categorized as normal, abnormal, and definitively diagnostic.
RESULTS: Fifteen patients were eligible for inclusion, 12 of which had abnormal histopathology results detected using EBUS. Three had normal histopathology, 2 were falsely identified (falsely postitive) by EBUS; and, 1 biopsy was performed based solely on radiographic findings, as EBUS was unable to detect an abnormal signal in the suspected region. The positive predictive value for detecting abnormal pathology is 86%. Definitive diagnosis was made in only 8 (53%) of the patients, 75% of whom were HIV infected.
CONCLUSION: Our findings suggest that EBUS may be useful in guiding transbronchial biopsies of interstitial infiltrates with respect to successful biopsy of abnormal histopathology. However the definitive-diagnosis yield remains low, except in HIV infected patients.
CLINICAL IMPLICATIONS: EBUS can potentially improve the efficiency of transbronchial biopsy of interstitial infiltrates. Our study supports future controlled studies to determine the sensitivity, specificity, and predictive values of EBUS if used in this role and the patient populations most likely to benefit.
DISCLOSURE: Eric Flenaugh, No Financial Disclosure Information; No Product/Research Disclosure Information