Endobronchial ultrasound-guided transbronchial biopsy for ground-glass opacity-predominant nodules in the lung periphery

Abstract

Objectives: Peripheral lung nodules containing ground-glass opacity (GGO), which include both pure GGN (nodules that contain only GGO) and part-solid GGN (nodules that contain both GGO and consolidation), are difficult to diagnose by conventional transbronchial biopsy (TBB) because they are not visible by fluoroscopy. Recently developed endobronchial ultrasound (EBUS)-guided TBB is useful for diagnosing these nodules. This study was performed to clarify the contribution of EBUS to the diagnostic yield of TBB for peripheral lung nodules containing GGO. Methods: We retrospectively reviewed the medical records of 41 patients (21 male, 20 female; median age, 72 years) with peripheral lung pure GGN or part-solid GGN who underwent EBUS-guided TBB. Results: The median diameter of the target lesions was 18.6 mm (range, 8.8–46.7 mm). There were seven pure GGN lesions and 34 part-solid GGN lesions. The total diagnostic yield was 65.9% (27/41). EBUS images could be obtained (positive) in 30 (73.1%) patients. Among the clinical factors studied, only a positive EBUS finding was significantly associated with a higher diagnostic yield (p=0.018). Diagnostic yield tended to be higher in patients with a positive CT bronchus sign (presence of a bronchus leading directly to the target lesion) and increased consolidation-to-tumor ratio. Conclusions: EBUS-guided TBB is useful for diagnosing GGN or part-solid GGN. Obtaining positive EBUS findings is important for successful TBB for lesions containing GGO.

Keywords

• ground-glass opacity
• endobronchial ultrasound (ebus)
• ct bronchus sign
• consolidation-to-tumor ratio (ctr)