Predictive Factors for Tuberculous Peripheral Pulmonary Lesions During Radial Endobronchial Ultrasound in Tuberculous-Endemic Region

<italic><bold>Introduction</bold></italic> Tuberculosis is a significant global health concern, especially in South East Asia. The diagnostic challenge arises when it presents as a peripheral pulmonary lesion (TB-PPL), mimicking lung cancer, and thus potentially causing treatment delays. The growing use of radial endobronchial ultrasound (rEBUS) for PPL biopsy highlights the need to identify predictive factors for TB-PPL, which is crucial for effective procedure planning, and ensuring healthcare worker safety during the aerosol-generating bronchoscope. <italic><bold>Methods</bold></italic> A six-year retrospective chart review at our institution focusing on adults who underwent rEBUS for PPL diagnosis. <italic><bold>Result</bold></italic> 387 PPLs were included in our cohort, 32% were TB-PPL and 68% were malignant-PPL. The median age was 63 (IQR 55-70) years, with the TB-PPL group significantly younger. The median size of the target lesion was 2.90 (IQR 2.26-4.00) cm. The overall rEBUS diagnostic yield was 85.3%, with a 1.3% pneumothorax risk. Multivariate analysis identified independent predictors for TB-PPL, including age <60 years (adj OR 2.635), target lesion size <2 cm (adj OR 2.385), upper lobe location (adj OR 2.020), presence of a cavity on pre-procedural CT (adj OR 4.186), and presence of rEBUS bronchogram (adj OR 2.722). These variables achieved an area under the curve of 0.729 (95% CI 0.673-0.795) with a diagnostic accuracy of 75.49% (95% CI 70.68-79.88). <bold><italic>Conclusion</italic></bold> In tuberculosis-endemic regions, a substantial number of PPLs are tuberculous. Despite non-specific radiological findings, our study identifies several independent predictors for TB-PPL, offering a valuable clinical prediction model.