Radial Probe Endobronchial Ultrasound for Peripheral Pulmonary Lesions: Initial Experience in an Indian Tertiary Healthcare Centre

Document Type : Original Article


1 Pulmonologist, Department of Pulmonary Medicine, Amrita Institute of Medical sciences & research centre, Amrita Vishwa Vidya Peetham , Kochi

2 Pulmonary Medicine, Department of Pulmonary Medicine, Amrita Institute of Medical sciences & research centre, Amrita Vishwa Vidya Peetham , Kochi

3 Pathologist, Department of Pathology, Amrita Institute of Medical sciences & research centre, Amrita Vishwa Vidya Peetham, Kochii


Introduction : Diagnosis of peripheral pulmonary nodules is confusing; therefore, an accurate and safe lung biopsy can prevent unnecessary invasive diagnostic procedures. This study soughtto study the diagnostic yield, sensitivity, specificity, and negative and positive predictive values (NPV and PPV) of radial probe endobronchial ultrasound (EBUS)-guided biopsy for peripheral pulmonary lesions.
Materials and Methods: Patients referred to the Division of Pulmonary Medicine for evaluation of peripheral pulmonary lesions were subjected to radial probe EBUS-guided transbronchial lung biopsy under conscious sedation after reviewing positron emission tomography scan/computed tomography results. The obtained specimens were considered diagnostic when the cytological, histopathological, or microbiological diagnosis was consistent with the clinical presentations.
Results: Totally, 14 procedures were performed on 13 patients with mean lesion size of 30.42 mm. Mean distance between the lesion and pleura was 1.17±0.68 cm, and the diagnostic yield of this technique was 78.57%. Furthermore, the sensitivity, specificity, and NPV were 70% (range: 34.75 to 93.33), 100% (range: 39.76 to 100), and 57.14% (range: 18.41 to 90.10), respectively. This procedure was not associated with any major complications.
Conclusion: Radial probe EBUS with satisfactory diagnostic yield and low complication rate is a promising tool for early diagnosis of lung cancer.


1.Simon GR, Turrisi A; American College of Chest Physicians. Management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007; 132:324S-339S
2. Tachibana K, Nakazato Y, Tsuchida S, Kazama T, Minato K, Yoshida T, et al. Immediate cytology improves accuracy and decreases complication rate in real-time computed tomography‐guided needle lung biopsy. Diagn Cytopathol. 2013; 41:1063-8.
3. Gildea TR, Mazzone PJ, Karnak D, Meziane M, Mehta AC. Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med. 2006; 174:982-9.
4. Eberhardt R, Anantham D, Herth F, Feller-Kopman D, Ernst A. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest. 2007; 131:1800-5.
5. Tamiya M, Okamoto N, Sasada S, Shiroyama T, Morishita N, Suzuki H, et al. Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under LungPoint guidance for small peripheral pulmonary
lesions. Respirology. 2013; 18:834-9.
6. Kikuchi E, Yamazaki K, Sukoh N, Kikuchi J, Asahina H, Imura M, et al. Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions. Eur Respir J. 2004; 24:533-7.
7. Sehgal IS, Dhooria S, Aggarwal AN, Behera D, Agarwal R. Use of radial probe endobronchial ultrasound for the diagnosis of peripheral pulmonary lesion: first report from India. Lung India. 2016; 33:212-5.
8. Liang L, Liu J, Buryanek J, Zhang S. CT-guided core needle biopsy of peripheral lung lesions with onsite adequate evaluation: a review of 215 cases. J Cytol Histol. 2014; S4:18-23.
9. Rittirak W, Sompradeekul S. Diagnostic yield of fluoroscopy-guided transbronchial lung biopsy in endobronchial lung lesion. J Med Assoc Thai. 2007; 90:68-73.
10. Shinagawa N, Yamazaki K, Onodera Y, Miyasaka K, Kikuchi E, Dosaka-Akita H, et al. CT-guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation. Chest. 2004; 125:1138-43.
11. Hsia DW, Jensen KW, Curran-Everett D, Musani AI. diagnosis of lung nodules with peripheral/radial endobronchial ultrasound-guided transbronchial biopsy. J Bronchology Interv Pulmonol. 2012; 19:5-11.
12. Kokkonouzis I, Lampaditis I, Charpidou A, kainisE, Syrigos K. Usefulness of endobronchial ultrasound (EBUS) in the diagnosis of peripheral pulmonary lesions in a general hospital. In Vivo. 2013; 27:655-60.
13. Paone G, Nicastri E, Lucantoni G, Dello Iacono R, Battistoni P, D'Angelo AL, et al. Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. Chest.
2005; 128:3551-7.
14. Peschke A, Wiedemann B, Höffken G, Koschel D. Forceps biopsy and suction catheter for sampling in pulmonary nodules and infiltrates. Eur Respir J. 2012; 39:1432-6.
15. Hayama M, Okamoto N, Suzuki H, Tamiya M, Shiroyama T, Tanaka A, et al. Radial endobronchial ultrasound with a guide sheath for diagnosis of peripheral cavitary lung lesions: a retrospective study. BMC Pulm Med. 2016;
16. Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J. 2011; 37:902-10.
17. Hibari KR, Goyal R, Nemani C, Avinash R, Ram B, Ullas B. Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: first case series from India. Lung India. 2017; 34:43-6.