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Endobronchial Ultrasonography Using a Guide Sheath Increases the Ability To Diagnose Peripheral Pulmonary Lesions Endoscopically^*

^* From the Departments of Thoracic Surgery (Drs. Kurimoto and Okimasa) and Respiratory Medicine (Drs. Maeda and Oiwa), National Hiroshima Hospital, Hiroshima; Department of Respiratory Medicine (Drs. Miyazawa and Miyazu), Hiroshima City Hospital, Hiroshima; and Department of Surgery (Dr. Murayama), Iwakuni Minami Hospital, Iwakuni, Japan.

Correspondence to: Noriaki Kurimoto, MD, 513 Jike, Saijyoucyou, Higashi-hiroshima City, Hiroshima Prefecture, 739-0041 Japan; e-mail; n.kurimoto{at}do7.enjoy.ne.jp

Study objective: To assess the ability of endobronchial ultrasonography (EBUS) using a guide sheath (EBUS-GS) to diagnose peripheral pulmonary lesions.

Method: We devised a technique for EBUS-GS covering a miniature probe, and 150 lesions were evaluated in a prospective open study. In this procedure, the probe covered by a guide sheath is introduced into the lesion via the working channel of a bronchoscope. The probe is withdrawn, while the guide sheath is left in situ. A brush or biopsy forceps is introduced through the guide sheath into the lesion.

Results: One hundred sixteen of 150 EBUS-GS procedures (77%) were diagnostic. Cases in which the probe was located within the lesion had a significantly higher diagnostic yield (105 of 121 cases, 87%) than when the probe was located adjacent to it (8 of 19 cases, 42%) [p < 0.0001, ²]. The diagnostic yield from EBUS-GS in lesions 10 mm (16 of 21 lesions, 76%), >10 to 15 mm (19 of 25 lesions, 76%; p = 0.99, ²), >15 to 20 mm (23 of 35 lesions, 66%; p = 0.41, ²), and > 20 to 30 mm (33 of 43 lesions, 77%; p = 0.96, ²) were similar, demonstrating the efficacy of EBUS-GS even in lesions 10 mm in diameter. In 54 of 81 lesions 20 mm, fluoroscopy was not able to confirm whether the forceps reached the lesion. However, the yield was the same with (67%, 18 of 27 lesions) and without (74%, 40 of 54 lesions) successful fluoroscopy (p = 0.96, ²). Moderate bleeding occurred in two patients (1%); there were no other complications.

Conclusions: EBUS-GS is a useful method for collecting samples from peripheral pulmonary lesions, even those too small to be visualized under fluoroscopy.

Key Words: endobronchial ultrasonography • guide sheath • peripheral pulmonary lesions

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