ABSTRACT
AIM: The aim of the study was to evaluate endobronchial ultrasound (EBUS) for peripheral lung lesions and to find the most cost effective combination of sampling techniques. MATERIALS: 264 patients with lesions suspicious of malignancy were recruited in Bergen and Aalesund, Norway from 2005 to 2008. METHODS: The study was a prospective randomised cohort study. EBUS was performed with a 1.7 mm rotating probe. X-ray fluoroscopy was used in both arms. The different sampling techniques were evaluated in a cost-effectiveness analysis. RESULTS: The detection rate for cancer was 36% in the EBUS group, 44% in the non-EBUS group (ns). Lesions below 3 cm and lesions assumed difficult to reach had significant lower detection rates in the EBUS group. Lesions visualised by EBUS had a higher detection rate for cancer than lesions not visualised by EBUS (62% vs. 19%, p<0.01). The cost of one additional positive sample was 1211 euro when brushing was added to biopsy. It was not cost effective to add washing or TBNA. CONCLUSION: EBUS did not increase the detection rate for cancer in peripheral lung lesions when bronchoscopy was performed by bronchoscopists at all levels of expertise. Biopsy and brushing was the most cost effective combination of sampling techniques.
Subject(s)
Bronchi/pathology , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Biopsy, Needle , Bronchi/diagnostic imaging , Bronchi/surgery , Carcinoma, Non-Small-Cell Lung/economics , Cohort Studies , Cost-Benefit Analysis , Endoscopy , Female , Fluoroscopy , Humans , Lung Neoplasms/economics , Male , Norway , Predictive Value of Tests , Prospective Studies , Sampling Studies , Sensitivity and Specificity , Specimen Handling/methods , Ultrasonography, Interventional/methods , Ultrasonography, Interventional/statistics & numerical dataABSTRACT
BACKGROUND: The choice of sampling techniques in bronchoscopy with sampling from a visible lesion will depend on the expected diagnostic yields and the costs of the sampling techniques. AIMS: The aim of this study was to determine the most economical combination of sampling techniques when approaching endobronchial visible lesions. METHODS: A cost minimization analysis was performed. All bronchoscopies from 2003 and 2004 at Haukeland university hospital, Bergen, Norway, were reviewed retrospectively for diagnostic yields. 162 patients with endobronchial disease were included. Potential sampling techniques used were biopsy, brushing, endobronchial needle aspiration (EBNA) and washings. Costs were estimated based on registration of equipment costs and personnel costs. Sensitivity analyses were performed to determine threshold values. RESULTS: The combination of biopsy, brushing and EBNA was the most economical strategy with an average cost of Euro 893 (95% CI: 657, 1336). The cost of brushing had to be below Euro 83 and it had to increase the diagnostic yield more than 2.2%, for biopsy and brushing to be more economical than biopsy alone. The combination of biopsy, brushing and EBNA was more economical than biopsy and brushing when the cost of EBNA was below Euro 205 and the increase in diagnostic yield was above 5.2%. CONCLUSION: In the current study setting, biopsy, brushing and EBNA was the most economical combination of sampling techniques for endobronchial visible lesions.
Subject(s)
Biopsy/economics , Bronchoscopy/methods , Budgets , Lung Neoplasms/diagnosis , Biopsy/methods , Bronchoalveolar Lavage/economics , Bronchoscopy/economics , Costs and Cost Analysis/methods , Decision Trees , Female , Humans , Lung Neoplasms/pathology , Male , Norway , Retrospective Studies , Specimen Handling/economics , Specimen Handling/methodsABSTRACT
Endobronchial ultrasonography (EBUS) using balloon-embedded probes may cause airway obstruction and requires a rapid scanning procedure. Three-dimensional (3-D) postprocessing of sequential 2-D images may allow detailed studies on a rapidly acquired image volume. We applied a 3-D reconstruction program on EBUS recordings acquired with a radial-scanning probe during a controlled pullback procedure in water-filled airways in five corpses. The aim was to acquire EBUS images under optimized conditions and to test a 3-D software program for postprocessing. Under post mortem conditions, 3-D images were obtained, allowing any-plane imaging and measurements, application of different rendering and visualization algorithms and merging of overlapping volumes.