title: Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without X-ray fluoroscopy.
abstract: OBJECTIVE
  We evaluated the feasibility and efficacy of transbronchial biopsy (TBB) and bronchial brushing by endobronchial ultrasonography (EBUS) with a guide sheath (GS) as a guide for diagnosing peripheral pulmonary lesions (PPLs) without radiographic fluoroscopy.
  
  
  METHODS
  One hundred twenty-one patients with 123 PPLs (mean diameter, 31.0 mm) whose bronchoscopic findings were normal.
  
  
  METHODS
  An EBUS-GS was inserted and advanced to the PPL without fluoroscopy. Once we obtained the EBUS image, the probe was withdrawn and the GS was left in place. TBB and/or bronchial brushing were performed via the GS. When an EBUS image could not be obtained, we changed to the bronchoscopic examination under fluoroscopy.
  
  
  RESULTS
  Seventy-six of 123 PPLs (61.8%) were diagnosed by EBUS-GS guidance without fluoroscopy. The diagnostic yield for PPLs > 20 mm in diameter (75.6%) was significantly higher than that for those <or= 20 mm in diameter (29.7%; p < 0.01). The PPLs located in the middle lobe and the lingular segment had significantly higher diagnostic yields (p < 0.05). When the bronchus leading to the PPL was identified on the CT scan, the yield was 79.2%. Moreover, the solid lesions had a higher diagnostic yield (67.0%) compared with nonsolid lesions (35.0%; p < 0.05). Multivariate analysis revealed that the diameter and the location of the PPL were independent predictors of diagnostic sensitivity by EBUS-GS-guided bronchoscopy (p < 0.05).
  
  
  CONCLUSIONS
  EBUS-GS-guided bronchoscopy without the use of radiographic fluoroscopy is effective for diagnosing PPLs. The diameter, location, and CT scan appearance of the PPLs, and the identification of the bronchus leading to the PPLs were valuable as factors related to a higher diagnostic sensitivity with this procedure.
authors.affiliation: Department of Pulmonary Diseases, National Hospital Organization Hokkaido Cancer Center, Kikusui-4-2, Shiroishiku, Sapporo 060-8638, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sukoh
authors.forename: Koichi
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Kenya
authors.initials: K
authors.lastname: Kanazawa
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Fukumoto
authors.forename: Masao
authors.initials: M
authors.lastname: Harada
authors.forename: Eiki
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munakata
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nishimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Isobe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D001980:Bronchi / Q000473:pathology; D001999:Bronchoscopy / Q000379:methods*; D019160:Endosonography / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012680:Sensitivity and Specificity