CT-guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation.
OBJECTIVE
We evaluated the feasibility, safety, and efficacy of CT-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope with navigation by virtual bronchoscopy (VB) for small peripheral pulmonary lesions of < 20 mm in diameter.


METHODS
A pilot study.


METHODS
A national university hospital.


METHODS
We performed CT-guided TBB after VB navigation for 25 patients with 26 small peripheral pulmonary lesions (average diameter, 13.2 mm) between June 1, 2001, and October 31, 2002. Of the 26 lesions, 10 were in the right upper lobe, 2 were in the right middle lobe, 6 were in the right lower lobe, and 8 were in the left upper lobe. Nineteen lesions were not detected on chest radiographs.


METHODS
VB images were reconstructed from helical CT scans. CT-guided TBB was performed using an ultrathin bronchoscope after studying the VB image.


RESULTS
CT-guided TBB was performed safely without any complications for all patients. The bronchi seen under VB imaging were highly consistent with the actual bronchi confirmed using an ultrathin bronchoscope. The ultrathin bronchoscope was inserted between the fifth and eighth generation bronchi. The average durations of the initial scan, the first biopsy, and the total examination were 5.46, 12.96, and 29.27 min, respectively. Seventeen lesions (65.4%) were diagnosed from pathology examinations (primary lung cancers, 13; atypical adenomatous hyperplasia, 1; metastatic cancer, 1; sarcoidosis, 1; and nontuberculous mycobacteriosis, 1). Diagnoses were not obtained for the remaining lesions due to an insufficient number of specimens (six specimens) or to the inability to reach the lesions even using the ultrathin bronchoscope (three specimens).


CONCLUSIONS
In summary, CT-guided TBB using an ultrathin bronchoscope with VB navigation was safely performed and was effective for diagnosing small peripheral pulmonary lesions.
First Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.
Naofumi
N
Shinagawa
Koichi
K
Yamazaki
Yuya
Y
Onodera
Kazuo
K
Miyasaka
Eiki
E
Kikuchi
Hirotoshi
H
Dosaka-Akita
Masaharu
M
Nishimura
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D020680:Bronchoscopes; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed