Evaluation of the radial endosonographic image of peripheral lung lesions for choosing the bronchobiopsies in the differential diagnosis of tuberculosis, mycobacteriosis and malignancy

Abstract

Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies. Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.