Assessment of using radial probe endobronchial ultrasound with a guide sheath to increase the yield rate of transbronchial biopsy: A prospective randomized trial

Abstract

Abstract Background Radial probe endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) with a guide sheath (GS) is widely used to diagnose peripheral lung lesions (PPLs), but there is no consensus on whether it increases the diagnostic yield. We conducted this prospective study to compare the diagnostic yield of the GS method to the conventional method without a GS. Material and methods From November 2019 to March 2023, patients with PPLs were recruited and randomly assigned to rEBUS-TBB with a GS (GS group) or without a GS (conventional group). The histopathology, cytology, and microbiology yield rates, as well as procedure time and post-procedure adverse events of the two groups were compared. Results A total of 102 patients were enrolled (54 in the GS group and 48 in the conventional group). The GS group exhibited a trend of increased pathology yield (75.9% vs. 68.8%, p = 0.418), while the yield rates of brushing cytology (64.3% vs. 42.9%, p = 0.030) and washing cytology (41.5% vs. 20.0%, p = 0.0443) were higher in the GS group. Meanwhile, the yield from GS washing culture was lower than the bronchial washing culture yield (0% vs. 57.1%, p = 0.017). The bleeding risk was also lower in the GS group (9.3% vs. 20.8%, p = 0.049), but the procedure time was longer in the GS group (17.6 ± 4.7 min vs. 15.1 ± 4.5 min, p = 0.008). Conclusion rEBUS TBB with a GS can increase the diagnostic yield of PPLs and decrease the risk of bleeding, while additional bronchial washing should be utilized to increase the microbiology yield. Trial registration: The study was registered at Clinicaltrials.gov (NCT04056273).