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Diagnostic Value of Endobronchial Ultrasonography With a Guide Sheath for Peripheral Pulmonary Lesions Without X-Ray Fluoroscopy^*

^* From the Department of Pulmonary Diseases (Drs. Yoshikawa, Sukoh, Fukumoto, Harada, and Isobe), National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; the First Department of Medicine (Drs. Yamazaki, Kikuchi, and Nishimura), Hokkaido University School of Medicine, Sapporo, Japan; and the Department of Pulmonary Medicine (Drs. Kanazawa and Munakata), Fukushima Medical University School of Medicine, Fukushima, Japan.

Correspondence to: Noriaki Sukoh, MD, PhD, Department of Pulmonary Diseases, National Hospital Organization Hokkaido Cancer Center, Kikusui-4–2, Shiroishiku, Sapporo 060-8638, Japan; e-mail: sukou{at}sap-cc.go.jp

Abstract

Study objectives: We evaluated the feasibility and efficacy of transbronchial biopsy (TBB) and bronchial brushing by endobronchial ultrasonography (EBUS) with a guide sheath (GS) as a guide for diagnosing peripheral pulmonary lesions (PPLs) without radiographic fluoroscopy.

Patients: One hundred twenty-one patients with 123 PPLs (mean diameter, 31.0 mm) whose bronchoscopic findings were normal.

Methods: An EBUS-GS was inserted and advanced to the PPL without fluoroscopy. Once we obtained the EBUS image, the probe was withdrawn and the GS was left in place. TBB and/or bronchial brushing were performed via the GS. When an EBUS image could not be obtained, we changed to the bronchoscopic examination under fluoroscopy.

Results: Seventy-six of 123 PPLs (61.8%) were diagnosed by EBUS-GS guidance without fluoroscopy. The diagnostic yield for PPLs > 20 mm in diameter (75.6%) was significantly higher than that for those 20 mm in diameter (29.7%; p < 0.01). The PPLs located in the middle lobe and the lingular segment had significantly higher diagnostic yields (p < 0.05). When the bronchus leading to the PPL was identified on the CT scan, the yield was 79.2%. Moreover, the solid lesions had a higher diagnostic yield (67.0%) compared with nonsolid lesions (35.0%; p < 0.05). Multivariate analysis revealed that the diameter and the location of the PPL were independent predictors of diagnostic sensitivity by EBUS-GS-guided bronchoscopy (p < 0.05).

Conclusions: EBUS-GS–guided bronchoscopy without the use of radiographic fluoroscopy is effective for diagnosing PPLs. The diameter, location, and CT scan appearance of the PPLs, and the identification of the bronchus leading to the PPLs were valuable as factors related to a higher diagnostic sensitivity with this procedure.

Key Words: bronchoscopy • endobronchial ultrasonography with guide sheath • fluoroscopy • lung cancer • peripheral pulmonary lesion