title: Endobronchial ultrasound-guided transbronchial lung biopsy in fluoroscopically invisible solitary pulmonary nodules: a prospective trial.
abstract: OBJECTIVE
  Transbronchial biopsy (TBBX) for solitary pulmonary nodules (SPNs) is usually performed under fluoroscopic guidance, but the diagnostic yield depends on lesion size and varies widely. Nodules < 3 cm frequently cannot be visualized fluoroscopically. An alternative guidance technique, endobronchial ultrasound (EBUS), also allows visualization of pulmonary nodules. This study assessed the diagnostic yield of EBUS-guided TBBX in fluoroscopically invisible SPNs.
  
  
  METHODS
  The study was a prospective trial using a crossover design.
  
  
  METHODS
  All patients with SPNs and indications for bronchoscopy were included in the study. An EBUS-guided examination was performed in patients with fluoroscopically invisible nodules. The EBUS probe was introduced through a guide catheter into the presumed segment. If a typical ultrasonic picture of solid tissue could be seen, the probe was removed and the catheter left in place. The biopsy forceps were introduced and specimens taken.
  
  
  RESULTS
  One hundred thirty-eight consecutive patients with SPNs were examined. Of those, 54 patients presented with SPNs that could not be visualized with fluoroscopy. The mean diameter of the nodules was 2.2 cm. In 48 patients (89%), the lesion was localized with EBUS, and in 38 patients (70%) the biopsy established the diagnosis. The 16 patients with undiagnosed SPNs were referred for surgical biopsy; 10 of those lesions were malignant and 6 were benign. The diagnosis in nine patients (17%) saved the patients from having to undergo a surgical procedure. The only complication was a pneumothorax in one patient.
  
  
  CONCLUSIONS
  EBUS-guided TBBX is a safe and very effective method for SPNs that cannot be visualized by fluoroscopy. The procedure may increase the yield of endoscopic biopsy in patients with these nodules and avert the need for surgical procedures.
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Thoraxklinik Heidelberg, Germany.
authors.forename: F J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: R
authors.initials: R
authors.lastname: Eberhardt
authors.forename: H D
authors.initials: HD
authors.lastname: Becker
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001999:Bronchoscopy; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D014741:Video Recording