A randomized controlled trial evaluating airway inspection effectiveness during endobronchial ultrasound bronchoscopy

Lonny Yarmus; Jason Akulian; Ricardo Ortiz; Richard Thompson; Karen Oakjones-Burgess; Sixto Arias; Roy Semaan; David Feller-Kopman; Hans Lee; Ko Pen Wang

doi:10.3978/j.issn.2072-1439.2015.09.42

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A randomized controlled trial evaluating airway inspection effectiveness during endobronchial ultrasound bronchoscopy

Journal article

Open access

Peer reviewed

A randomized controlled trial evaluating airway inspection effectiveness during endobronchial ultrasound bronchoscopy

Lonny Yarmus, Jason Akulian, Ricardo Ortiz, Richard Thompson, Karen Oakjones-Burgess, Sixto Arias, Roy Semaan, David Feller-Kopman, Hans Lee and Ko Pen Wang

Journal of thoracic disease, Vol.7(10), pp.1825-1832

2015-10

DOI: https://doi.org/10.3978/j.issn.2072-1439.2015.09.42

PMCID: PMC4635275

PMID: 26623106

Abstract

Lung cancer

endobronchial ultrasound

bronchoscopy

Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) has revolutionized the evaluation of patients with mediastinal and hilar adenopathy. Limitations of conventional endobronchial ultrasound (C-EBUS) bronchoscopes include the inability to perform a complete airway inspection, low definition optics, and limited maneuverability. These limitations require the use of a standard bronchoscope to perform an airway examination prior to the EBUS procedure. Recently, a hybrid endobronchial ultrasound (H-EBUS) bronchoscope with high definition optics and increased maneuverability has been introduced. Our objective was to assess the ability of H-EBUS to perform a full airway inspection and TBNA. Patients referred for EBUS-TBNA were prospectively randomized to either form of EBUS from November 2013 to January 2014. The primary outcome was the airway segment visualization in each lobe using an EBUS bronchoscope. Secondary outcomes included the number of bronchoscopes used per procedure, procedure length, diagnostic yield and specimen adequacy. Sixty-two consecutive patients undergoing EBUS-TBNA were randomized to H-EBUS (n=30) or C-EBUS (n=32). In cases in which EBUS-TBNA was the only procedure performed (n=32), use of a second bronchoscope to perform an adequate airway inspection was significantly higher in C-EBUS compared to H-EBUS (5 vs. 0, P=0.046). There was better segmental visualization achieved in multiple lobes when using H-EBUS (P<0.01). No differences in TBNA sample diagnostic yield, specimen adequacy or procedure time were noted when comparing bronchoscopes (P= NS). Use of an H-EBUS may improve the ability to perform an adequate airway inspection potentially obviating the need for a conventional bronchoscope.

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.199 Lung Cancer; 1.199.425 Lung Cancer
Web Of Science research areas: Respiratory System
ESI research areas: Clinical Medicine

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Details

Title: A randomized controlled trial evaluating airway inspection effectiveness during endobronchial ultrasound bronchoscopy
Creators: Lonny Yarmus - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Jason Akulian - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Ricardo Ortiz - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Richard Thompson - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Karen Oakjones-Burgess - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Sixto Arias - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Roy Semaan - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
David Feller-Kopman - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Hans Lee - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Ko Pen Wang - 1 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA ; 2 Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; 3 Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Publication Details: Journal of thoracic disease, Vol.7(10), pp.1825-1832
Publisher: China
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Pulmonary, Critical Care & Sleep Medicine
Language: English
Resource Type: Journal article
PMID: 26623106
PMCID: PMC4635275
Record Identifier: 991031561236102976