Radial probe endobronchial ultrasound for peripheral pulmonary lesions. Initial experience of a center during COVID-19 pandemic.

I. Duarte*^a (Dr), J. Rodrigues^a (Dr), D. Silva^a (Dr), D. Maia^a (Dr), AS. Santos^a (Dr), R. Gerardo^a (Dr), A. Mineiro^a (Prof), A. Miguel^a (Prof)

^a Centro Hospitalar e Universitário de Lisboa Central - Hospital Santa Marta, Lisbon, PORTUGAL

* inesfduarte2@gmail.com

Background

Radial probe endobronchial ultrasound (RP-EBUS) is an important tool in peripheral pulmonary lesions diagnostic. The diagnostic yield depends on the lesion size and sampling tools used. In this study, we present our experience during COVID-19 pandemic.

Methods

We retrospectively reviewed data from 27 procedures (25 patients) who underwent RP-EBUS for investigation of peripheral pulmonary lesions between May 2020 and April 2022. Demographic, clinical and outcome data were collected and analyzed. Fluoroscopy was not used. Statistics was performed with SPSS 25.

Results

Twenty-five patients were included with a median age of 66 (46-88) years-old and 20 (74%) were male. RP-EBUS was used for diagnostic purposes, in 81.4% (n=22/27) suspected primary lung cancer and in 18.5% (n=5/27) suspected metastatic lesions. Median lesion size was 2.4 (1.1-8.2)cm. In 77,8% (n=21/27) cases the lesion was identified by RP-EBUS (in 57.1% concentric identification). Considering the combined results of bronchial washing, bronchial brushing, transbronchial biopsy and transbronchial needle aspiration the overall diagnostic accuracy was 59,3% (16/27) of cases. There were 68.75% (n=11/16) cases of primary lung cancer, 12.5% (n=2/16) diagnosis of tuberculosis, 6.25% (n=1/16) sarcoidosis and 6.25% (n=1/16) cryptogenic organizing pneumonia. In 40.7% (n=11/27) of the cases it was not possible to obtain a diagnosis. Of these, 27,3% (n=4/11) cases had a final diagnosis of lung cancer by transthoracic biopsy; one repeated RP-EBUS verifying the diagnosis of lung cancer; one case of sarcoidosis after mediastinoscopy and 45.5% (n=5/11) are still under investigation and/or surveillance. No major bleeding or pneumothorax was observed.

Conclusion

Although the suspected lesion was identified in the majority of cases, the diagnostic yield was low which could be related to the high frequency of eccentric lesions and to the learning curve . RP-EBUS without fluoroscopy seems to be a safe and useful procedure for the diagnosis of peripheral lung lesions.

Disclosure of funding source(s): none