Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically.
OBJECTIVE
To assess the ability of endobronchial ultrasonography (EBUS) using a guide sheath (EBUS-GS) to diagnose peripheral pulmonary lesions.


METHODS
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 The probe is withdrawn, while the guide sheath is left in situ.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, chi(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, chi(2)), >15 to </= 20 mm (23 of 35 lesions, 66%; p = 0.41, chi(2)), and > 20 to </= 30 mm (33 of 43 lesions, 77%; p = 0.96, chi(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, chi(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.
Kurimoto
Noriaki
N
Departments of Thoracic Surgery, National Hiroshima Hospital, Hiroshima, Japan. n.kurimoto@do7.enjoy.ne.jp
Miyazawa
Teruomi
T
Okimasa
Seiji
S
Maeda
Akihiro
A
Oiwa
Hiroshi
H
Miyazu
Yuka
Y
Murayama
Masaki
M
D000368:Aged; D001706:Biopsy / Q000295:instrumentation; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D019160:Endosonography / Q000295:instrumentation*; D004867:Equipment Design; D005471:Fluoroscopy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D013673:Technology Assessment, Biomedical; D014159:Transducers