Integrated strategy combining endobronchial ultrasound with positron emission tomography to diagnose peripheral pulmonary lesions

Background: Endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) and fluorodeoxyglucose positron emission tomography (FDG-PET) have been widely used in the diagnosis of peripheral pulmonary lesions (PPLs). This study was conducted to determine the diagnostic value of EBUS-TBLB combined with FDG-PET in the assessment of PPLs. Methods: The clinical data of 76 patients with PPLs who received both FDG-PET and EBUS-TBLB from January 2016 to February 2018 were retrospectively evaluated. Further subgroup analysis was performed according to lesion diameter (≤20 mm or >20 mm). Related diagnostic indices were calculated and compared between groups. Results: When combining EBUS-TBLB with FDG-PET, the diagnostic accuracy rate, sensitivity, specificity, Youden's index, positive predictive value, and negative predictive value for PPLs were 86.8%, 90.2%, 73.3%, 63.5%, 93.2%, and 64.7%, respectively. In addition, the diagnostic accuracy rate of the combined approach was significantly higher than the single EBUS-TBLB and FDG-PET (P < 0.01 and P < 0.05, respectively), and its Youden's index was also at a higher level. When stratified by lesion diameter, the combined approach showed a significantly higher diagnostic accuracy rate (P < 0.05) and a higher Youden's index for PPLs >20 mm than PPLs ≤20 mm. In addition, we found that positive bronchus sign and probe within the probe were two important factors conducing to enhancing the diagnostic accuracy rate for EBUS-TBLB. Conclusions: An integrated approach combining EBUS-TBLB with FDG-PET is particularly useful for diagnosing PPLs, and the improved diagnostic yields were especially evident for PPLs >20 mm.