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(Chest. 2005;128:388-393.)
© 2005 American College of Chest Physicians

Endobronchial Ultrasonography Guidance for Transbronchial Needle Aspiration Using a Double-Channel Bronchoscope*

Koji Kanoh, MD; Teruomi Miyazawa, MD, PhD, FCCP; Noriaki Kurimoto, MD, PhD; Yasuo Iwamoto, MD, PhD; Yuka Miyazu, MD and Nobuoki Kohno, MD, PhD, FCCP

* From the Department of Internal Medicine (Dr. Kanoh), Fukushima Co-op Hospital, Hiroshima; the Department of Pulmonary Medicine (Drs. Miyazawa, Iwamoto, and Miyazu), Hiroshima City Hospital, Hiroshima; the Department of Molecular and Internal Medicine (Dr. Kohno), Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima; and the Department of Surgery (Dr. Kurimoto), Hiroshima National Hospital, Higashi-Hiroshima, Japan.

Correspondence to: Teruomi Miyazawa, MD, PhD, FCCP, Director, Department of Pulmonary Medicine, Hiroshima City Hospital, 7–33 Motomachi, Naka-ku, Hiroshima, Japan; e-mail: miyazawt{at}carrot.ocn.ne.jp

Study objectives: Endobronchial ultrasonography (EBUS) is used as guidance for transbronchial needle aspiration (TBNA), and real-time imaging of the needle position cannot be confirmed with a single-channel bronchoscope. We assessed the usefulness of EBUS-guided TBNA using a double-channel bronchoscope (EBUS-D), which provides real-time needle position, and compared it with EBUS-guided TBNA using a single-channel bronchoscope (EBUS-S).

Design: Randomized, comparative prospective study.

Setting: Hiroshima City Hospital, a tertiary-referral teaching hospital.

Patients: Between January 2000 and August 2003, 55 patients with intrathoracic lymphadenopathy were included. Patients were randomized to undergo EBUS-D (n = 30) or EBUS-S (n = 25).

Methods: EBUS-D: The EBUS probe and TBNA catheter were inserted simultaneously through a double-channel bronchoscope. Once the needle placement in the lesion was confirmed by EBUS, TBNA was performed. EBUS-S: The EBUS probe was removed after the determination of the penetration site. Then, the TBNA catheter was inserted and TBNA was performed.

Results: All the lymph nodes could be visualized with EBUS in each group of patients. In the EBUS-D group, the TBNA needle was visualized as a hyperechoic point on the real-time EBUS image. The diagnostic accuracy rate of EBUS-D and EBUS-S were statistically significantly different (97% vs 76%, respectively; p = 0.025). On second attempt of TBNA, the diagnostic rate of the EBUS-D group was superior to that of the EBUS-S group (85.7% vs 33.3%, respectively; p = 0.036). The mean number of penetrations was 1.24 in the EBUS-D group and 1.36 in the EBUS-S group. No complications were observed in the EBUS-D group, but a self-limiting hemorrhage occurred in a patient in the EBUS-S group.

Conclusion: EBUS-D is useful for diagnosing intrathoracic lymphadenopathy, and the obtained specimen with real-time confirmation of the needle is directly proportional to an accurate diagnosis.

Key Words: bronchoscopy • intrathoracic lymphadenopathy • endobronchial ultrasonography • transbronchial needle aspiration






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Copyright © 2005 by the American College of Chest Physicians.