Evaluating Diagnostic Yield and Accuracy as Key Performance Metrics in Pulmonary Lung Lesions

Junsu Choe¹Hyunseung Nam¹Hwan-ho Cho²Sun Hye Shin¹Byeong-Ho Jeong¹Sang-Won Um¹Hojoong Kim¹Kyungjong Lee^1,3*

• ¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
• ²Department of Electronics Engineering, Incheon National University, Incheon, Republic of Korea
• ³Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea

Objective: A conservative definition of diagnostic yields for assessing the performance of guided bronchoscopy has been proposed, but it has yet to be validated in practice.Patients who underwent radial endobronchial ultrasound (R-EBUS) between April 2020 and April 2023 were included in the study. Diagnostic results were classified as malignant or non-malignant based on the post-lung-biopsy pathology. Non-malignant results were further categorized into specific benign (SB), nonspecific benign (NSB), atypical cells, and non-diagnostic (ND). All non-malignant lesions were confirmed using alternative biopsy methods or chest computed tomography (CT) during a followup of over 1 year. Diagnostic yield and accuracy were calculated using pre-defined methods (Box below). Predictors of sampling success were identified in a logistic regression analysis.Results: Among the 736 patients evaluated in this study, R-EBUS-guided TBLB revealed malignancy in 431 (58.6%) patients. The remaining 305 (41.4%) patients with non-malignant lesions were classified as SB (8.3%), NSB (21.3%), atypia (4.6%), and ND (7.2%). Diagnostic yield vs. accuracy values based on conservative, intermediate, and liberal definitions were 67% vs. 67%, 88% vs. 77%, and 100% vs. 79%, respectively. Thus, for the conservative definition, diagnostic accuracy and diagnostic yield were identical. Significant predictive factors for successful lung biopsy according to the conservative diagnostic yield included lesion size (> 20 mm), CT-bronchus subclassification (Ia, Ib), and radial probe position within the lesion.Our study validated the use of the conservative definition of diagnostic yield as a reliable diagnostic endpoint for evaluating the performance of guided bronchoscopy.