Diagnostic utility of adding needle aspiration (using PeriView FLEX needle) to radial endobronchial ultrasound guide sheath transbronchial lung biopsy: a single center retrospective study

Background: Radial endobronchial ultrasound (rEBUS) guide sheath (GS) transbronchial lung biopsy (TBLB) improves the diagnostic yield of peripheral lung lesions (PLL). However, its diagnostic yield is approximately 60%. We aimed to evaluate the diagnostic utility of adding rEBUS GS transbronchial needle aspiration (TBNA) using PeriView FLEX needle (Olympus, Tokyo, Japan) to rEBUS GS TBLB. Methods: In this retrospective study, we initially screened 124 PLLs in 123 patients who underwent rEBUS GS procedures for PLLs from December 2020 to August 2021. The analysis was performed on 74 PLLs in 73 patients who underwent both rEBUS GS TBLB and TBNA. Results: PLLs showed the following characteristics: lesion size [mean +/- standard deviation (SD)], 24 +/- 12 mm; nature (solid vs. subsolid), 59 (79.7%) vs. 15 (20.3%); distance from the pleura (mean +/- SD), 14 +/- 14 mm; rEBUS visualization type (probe within PLL vs. probe adjacent to PLL), 56 (75.7%) vs. 18 (24.3%). Among 74 PLLs, 47 (63.5%) were successfully diagnosed by rEBUS GS TBLB. In 27 PLLs not diagnosed by rEBUS GS TBLB, 5 (18.5%) were further diagnosed by rEBUS GS TBNA [overall diagnostic yield: 70.3% (52/74)]. EBUS visualization type of "probe adjacent to PLL" was a significant factor associated with the diagnostic yield of additional rEBUS GS TBNA. Conclusions: In rEBUS GS procedures for PLLs, the diagnostic yield might be improved by implementing TBNA in addition to TBLB. In particular, additional TBNA is preferable if the probe is adjacent to the lesion rather than within the lesion on rEBUS.