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This Article Full Text (PDF) Free All Versions of this Article: chest.07-0637v1 132/2/603    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yamada, N. Articles by Nishimura, M. Search for Related Content PubMed PubMed Citation Articles by Yamada, N. Articles by Nishimura, M.

Factors Related to Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Small Peripheral Pulmonary Lesions

First Department of Medicine (Drs. Yamada, Yamazaki, Asahina, Kikuchi, Shinagawa, Oizumi and Nishimura), Hokkaido University School of Medicine, Sapporo, Japan; Department of Surgery, Division of Chest Surgery (Dr. Kurimoto), St.Marianna University School of Medicine, Kawasaki, Japan

kyamazak{at}med.hokudai.ac.jp

Abstract

Study objectivesTo evaluate factors predicting the diagnostic yield of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) in small peripheral pulmonary lesions (PPLs) 30 mm in mean diameter.

DesignRetrospective analysis.

Patients and methodsOne hundred and fifty-five consecutive patients with 158 small PPLs underwent TBB using EBUS-GS.

ResultsA definitive diagnosis was established by TBB using EBUS-GS in 106 PPLs (67%). The diagnostic yield of PPLs 15 mm (40%) was significantly lower than that of 15 < PPLs 30 mm (76%) (p < 0.001). PPLs in which the probe was positioned within the PPL on the EBUS image had a higher diagnostic yield (83%) than PPLs in which the probe was positioned adjacent to (61%) or outside (4%) the PPL (p < 0.001). There were no significant differences in diagnostic yield for underlying disease, location, CT bronchus sign, operator, or type of EBUS probe. In the multivariate analysis, only the position of the probe (within or adjacent to the PPL when judged against outside the PPL) was determined to be a significant factor predicting diagnostic yield. On the other hand, a pathological diagnosis was established with the first, second, third, fourth, and fifth biopsy specimens in 65, 80, 87, 91, and 97% of PPLs, respectively.

ConclusionsThe position of the probe (within or adjacent to) is a significant factor predicting diagnostic yield of TBB using EBUS-GS for small PPLs, and the optimum number of biopsy specimens is at least five.

Key Words: peripheral pulmonary lesions • endobronchial ultrasonography with a guide sheath • transbronchial biopsy