title: Endobronchial ultrasonography with distance for peripheral pulmonary lesions.
abstract: BACKGROUND
  We assessed the effectiveness of applying the distance from the orifice of the bronchus to visualized peripheral pulmonary lesion (PPL) under endobronchial ultrasonography (EBUS) to transbronchial biopsy (TBB), as an alternative to EBUS with a guide sheath (GS) and fluoroscopy.
  
  
  METHODS
  From October 2004 to July 2005, a total of 158 consecutive patients with solitary PPLs, which were not visualized under flexible video bronchoscopy, were received EBUS for advanced localization subsequently. One hundred and thirteen of 158 patients with solitary PPLs which were visualized on EBUS image were included in this prospective study and randomly divided into two groups for TBB using different methods. In group EBUS-D (57 patients) the distance from the bronchial orifice to pulmonary lesion was measured, then the biopsy forceps were advanced to this measured distance and biopsy followed. In group EBUS (56 patients) the biopsy forceps were advanced regardless of distance. The diagnostic yields were then compared.
  
  
  RESULTS
  TBBs in group EBUS-D patients had a significantly higher diagnostic yield (45/57, 78.9%) than group EBUS patients (32/56, 57.1%) [P=0.013]. Size and location of lesion, duration of EBUS, diagnosis of malignancy, and whether the probe was located within the lesion on EBUS image did not differ between these two groups. Mild bleeding occurred in three patients in group EBUS-D and two in group EBUS. One group EBUS patient had a self-limited pneumothorax.
  
  
  CONCLUSIONS
  Measuring and applying the distance between the orifice of bronchus and the lesion could increase the diagnostic yield of EBUS-guided TBBs for PPLs.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Hsiu
authors.initials: YH
authors.lastname: Chung
authors.forename: Chien-Hao
authors.initials: CH
authors.lastname: Lie
authors.forename: Tung-Ying
authors.initials: TY
authors.lastname: Chao
authors.forename: Yi-Hsi
authors.initials: YH
authors.lastname: Wang
authors.forename: An-Shen
authors.initials: AS
authors.lastname: Lin
authors.forename: Jui-Long
authors.initials: JL
authors.lastname: Wang
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001980:Bronchi / Q000000981:diagnostic imaging*; D001999:Bronchoscopy / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography