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. 2016 Jan 1;193(1):68-77.
doi: 10.1164/rccm.201507-1332OC.

Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry

David E Ost  1 , Armin Ernst  2 , Xiudong Lei  3 , Kevin L Kovitz  4 , Sadia Benzaquen  5 , Javier Diaz-Mendoza  6 , Sara Greenhill  6 , Jennifer Toth  7 , David Feller-Kopman  8 , Jonathan Puchalski  9 , Daniel Baram  10 , Raj Karunakara  11 , Carlos A Jimenez  1 , Joshua J Filner  12 , Rodolfo C Morice  1 , George A Eapen  1 , Gaetane C Michaud  9 , Rosa M Estrada-Y-Martin  13 , Samaan Rafeq  2 , Horiana B Grosu  1 , Cynthia Ray  6 , Christopher R Gilbert  7 , Lonny B Yarmus  8 , Michael Simoff  6 ; AQuIRE Bronchoscopy Registry
Collaborators, Affiliations

Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry

David E Ost et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Advanced bronchoscopy techniques such as electromagnetic navigation (EMN) have been studied in clinical trials, but there are no randomized studies comparing EMN with standard bronchoscopy.

Objectives: To measure and identify the determinants of diagnostic yield for bronchoscopy in patients with peripheral lung lesions. Secondary outcomes included diagnostic yield of different sampling techniques, complications, and practice pattern variations.

Methods: We used the AQuIRE (ACCP Quality Improvement Registry, Evaluation, and Education) registry to conduct a multicenter study of consecutive patients who underwent transbronchial biopsy (TBBx) for evaluation of peripheral lesions.

Measurements and main results: Fifteen centers with 22 physicians enrolled 581 patients. Of the 581 patients, 312 (53.7%) had a diagnostic bronchoscopy. Unadjusted for other factors, the diagnostic yield was 63.7% when no radial endobronchial ultrasound (r-EBUS) and no EMN were used, 57.0% with r-EBUS alone, 38.5% with EMN alone, and 47.1% with EMN combined with r-EBUS. In multivariate analysis, peripheral transbronchial needle aspiration (TBNA), larger lesion size, nonupper lobe location, and tobacco use were associated with increased diagnostic yield, whereas EMN was associated with lower diagnostic yield. Peripheral TBNA was used in 16.4% of cases. TBNA was diagnostic, whereas TBBx was nondiagnostic in 9.5% of cases in which both were performed. Complications occurred in 13 (2.2%) patients, and pneumothorax occurred in 10 (1.7%) patients. There were significant differences between centers and physicians in terms of case selection, sampling methods, and anesthesia. Medical center diagnostic yields ranged from 33 to 73% (P = 0.16).

Conclusions: Peripheral TBNA improved diagnostic yield for peripheral lesions but was underused. The diagnostic yields of EMN and r-EBUS were lower than expected, even after adjustment.

Keywords: bronchoscopy; electromagnetic navigation; endobronchial ultrasound; lung cancer; transbronchial biopsy.

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References

    1. Rivera MP, Mehta AC American College of Chest Physicians. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) Chest. 2007;132(3) Suppl:131S–148S. - PubMed
    1. Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest. 2000;117:1049–1054. - PubMed
    1. Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS.Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer3rd edAmerican College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013. 143:e93S–e120S - PMC - PubMed
    1. Rivera MP, Mehta AC, Wahidi MM.Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013. 143:e142S–e165S - PubMed
    1. Wang Memoli JS, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest. 2012;142:385–393. - PMC - PubMed

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