SESSION TITLE: EBUS and Image-Guided Bronchoscopy
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Radial endobronchial ultrasound (EBUS-R) has been shown to improve bronchoscopic diagnosis of peripheral pulmonary lesions (PPL). However, it is unknown whether concurrent use of fluoroscopy during EBUS-R improves diagnostic yield. We conducted a randomized trial to determine the impact of fluoroscopy on EBUS-R diagnostic yield. Complication rates, sedation and procedural duration were compared as secondary end points.
METHODS: Consecutive subjects who underwent EBUS-R for the diagnosis of a PPL from June 2013 to December 2014 were prospectively included. A total of 133 patients were randomized in two groups: Non-Fluoroscopy (NF) (n=67) vs Fluoroscopy (F) (n=66). Under conscious sedation, EBUS-R was performed using a 20-MHz radial miniprobe introduced via a guide-sheath. When the PPL was localized with EBUS-R, the probe was removed and transbronchial biopsies, fine needle aspirations and cytological brushing were obtained via the guide sheath. For patients in the F group, EBUS-R and tissue sampling were performed under fluoroscopic guidance. Procedures were performed by six different interventional pulmonologists. Diagnostic yield, complication rates, use of sedatives and procedural duration were compared between groups.
RESULTS: At baseline, groups were similar regarding PPL size (31.5 mm vs 33.6 mm, p = NS), pleural-nodule distance (12.2 mm vs 12.6 mm, p = NS) or presence of bronchus sign [47 (70%) vs 51 (77%), p = NS]. Fifty-five PPLs in the NF vs 49 PPLs in the F group were localized by EBUS-R (p=NS). In those subjects in which PPL was localized, there was no difference between groups regarding diagnostic yield [22 (40%) vs 27 (55%), p = NS]. Total procedural duration (31.9 mins vs 30.7 mins, p = NS), complication rate or use of sedatives were also comparable.
CONCLUSIONS: The addition of fluoroscopy during EBUS-R did not increase the diagnostic yield for peripheral pulmonary lesion. It also had no influence on complication rates, total procedural duration and sedation amount.
CLINICAL IMPLICATIONS: Radial EBUS can be performed safely without fluoroscopy. Radial EBUS diagnostic yield does not improve with fluoroscopy.
DISCLOSURE: The following authors have nothing to disclose: Sebastien Nguyen, Fabien Rolland, Stephane Beaudoin, Francis Laberge, Mathieu Simon, Noel Lampron, Simon Martel, Michel Laviolette, Antoine Delage
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