title: A randomised trial of endobronchial ultrasound guided sampling in peripheral lung lesions.
abstract: OBJECTIVE
  The aim of the study was to evaluate endobronchial ultrasound (EBUS) for peripheral lung lesions and to find the most cost effective combination of sampling techniques.
  
  
  METHODS
  264 patients with lesions suspicious of malignancy were recruited in Bergen and Aalesund, Norway from 2005 to 2008.
  
  
  METHODS
  The study was a prospective randomised cohort study. EBUS was performed with a 1.7 mm rotating probe. X-ray fluoroscopy was used in both arms. The different sampling techniques were evaluated in a cost-effectiveness analysis.
  
  
  RESULTS
  The detection rate for cancer was 36% in the EBUS group, 44% in the non-EBUS group (ns). Lesions below 3 cm and lesions assumed difficult to reach had significant lower detection rates in the EBUS group. Lesions visualised by EBUS had a higher detection rate for cancer than lesions not visualised by EBUS (62% vs. 19%, p<0.01). The cost of one additional positive sample was 1211 euro when brushing was added to biopsy. It was not cost effective to add washing or TBNA.
  
  
  CONCLUSIONS
  EBUS did not increase the detection rate for cancer in peripheral lung lesions when bronchoscopy was performed by bronchoscopists at all levels of expertise. Biopsy and brushing was the most cost effective combination of sampling techniques.
authors.affiliation: Department of internal medicine, Helse Sunnmøre, Aalesund, Norway. Kjetil.Roth@helse-sunnmore.no
authors.forename: Kjetil
authors.initials: K
authors.lastname: Roth
authors.forename: Tomas Mikal
authors.initials: TM
authors.lastname: Eagan
authors.forename: Alf Henrik
authors.initials: AH
authors.lastname: Andreassen
authors.forename: Friedemann
authors.initials: F
authors.lastname: Leh
authors.forename: Jon Andrew
authors.initials: JA
authors.lastname: Hardie
mesh_terms: D001707:Biopsy, Needle; D001980:Bronchi / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000191:economics / Q000473:pathology*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology*; D008297:Male; D009664:Norway; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods / Q000706:statistics & numerical data