title: Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules.
abstract: OBJECTIVE
  This study aimed to investigate the diagnostic utility of peripheral endobronchial ultrasound (pEBUS) followed by as-needed electromagnetic navigation bronchoscopy (ENB) for sampling peripheral lung nodules.
  
  
  METHODS
  The study was a single-arm, prospective cohort study of patients with peripheral lung nodules. Peripheral lung lesion localization was initially performed using a pEBUS probe with guide sheath. If localization failed with pEBUS alone, ENB was used to help identify the lesion. Transbronchial biopsy, bronchial brush, transbronchial needle aspiration and bronchial washings were performed.
  
  
  RESULTS
  Sixty patients were enrolled with average lesion size of 27 mm and mean pleural distance of 20 mm. Lesions were found with pEBUS alone in 75% of cases. The addition of ENB improved lesion localization to 93%. However, diagnostic yield for pEBUS alone and pEBUS with ENB were 43% and 50%, respectively. Factors predicting need for ENB use included smaller lesion size and absence of an air bronchus sign on computed tomography.
  
  
  CONCLUSIONS
  ENB improves localization of lung lesions after unsuccessful pEBUS but is often not sufficient to ensure confirmation of a specific diagnosis. Technical improvements in sampling methods could improve the diagnostic yield.
authors.affiliation: University of Calgary, Calgary, Alberta, Canada. cheec@ucalgary.ca
authors.forename: Alex
authors.initials: A
authors.lastname: Chee
authors.forename: David R
authors.initials: DR
authors.lastname: Stather
authors.forename: Paul
authors.initials: P
authors.lastname: Maceachern
authors.forename: Simon
authors.initials: S
authors.lastname: Martel
authors.forename: Antoine
authors.initials: A
authors.lastname: Delage
authors.forename: Mathieu
authors.initials: M
authors.lastname: Simon
authors.forename: Elaine
authors.initials: E
authors.lastname: Dumoulin
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D055590:Electromagnetic Phenomena; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000473:pathology