Factors affecting the success of peripheral pulmonary lesion diagnosis via transbronchial needle aspiration and transbronchial biopsy when the probe is adjacent to the lesion on radial endobronchial ultrasound: A multicenter retrospective observational study

Background Radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy (TBB) is a useful method for diagnosing peripheral pulmonary lesions (PPLs). However, the diagnostic yield of this method for PPLs is unsatisfactory as the R-EBUS probe is not always located within the lesion. Nevertheless, R-EBUS-guided transbronchial needle aspiration (TBNA) followed by TBB (TBNA/TBB) has the potential to increase the diagnostic yield for lesions with adjacent orientation on R-EBUS. However, data on the diagnostic yield, safety, and success factors associated with the diagnosis using this technique for such lesions are limited. Methods Consecutive patients who underwent R-EBUS-guided TBNA/TBB for lesions with adjacent orientation on R-EBUS between 1 April 2019, and 31 March 2022, at three institutions (Nagoya University Hospital, Toyohashi Municipal Hospital, and Handa City Hospital) were retrospectively analyzed. The diagnostic yield, factors affecting the success of the diagnosis, and complications associated with R-EBUS-guided TBNA/TBB for the aforementioned lesions were investigated. Results Lesions from 75 patients were analyzed. The overall diagnostic yield of the lesions was 56/75 (74.7%). Multivariate analysis revealed that the close proximity of the probe to the edge of the PPL on an R-EBUS image before sampling (P = 0.012) and the visibility on chest radiography (P = 0.023) significantly affected the diagnostic yield via R-EBUS-guided TBNA/TBB. No major complications occurred. Conclusions R-EBUS-guided TBNA/TBB might be safe and effective in improving the diagnostic yield for lesions with adjacent orientation on R-EBUS, particularly when the lesion is in close proximity to the probe and is visible on chest radiography.