title: Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under LungPoint guidance for small peripheral pulmonary lesions.
abstract: OBJECTIVE
  The yield of biopsy performed during bronchoscopy is reduced if the lesion is smaller than 30 mm. We evaluated the performance of a new diagnostic technique combining endobronchial ultrasonography with a guide sheath (EBUS-GS) and a virtual bronchoscopic navigation system, LungPoint (Broncus Technologies, Inc., Mountain View, CA, USA), for the diagnosis of small (≤30 mm) peripheral pulmonary lesions (PPL).
  
  
  METHODS
  Between May 2011 and December 2011, we recruited 68 consecutive patients presenting with a PPL 30 mm or less in diameter determined by chest computed tomography. We used the LungPoint system before bronchoscopy to identify the bronchus into which the bronchoscope should be advanced. We used a thin bronchoscope. EBUS-GS was performed using an endoscope ultrasonography system equipped with a 20-MHz mechanical radial-type probe. We used a guide sheath with an external diameter of 1.95 mm, thin forceps and brushing.
  
  
  RESULTS
  The diagnostic yield of the 68 PPL was 77.9%; it was 83.7% and 68.0% for the malignant and benign lesions, respectively. Notably, three cases were diagnosed by transbronchial needle-aspiration cytology alone. Univariate and multivariate analyses showed that the EBUS probe localization was the most significant contributor to successful diagnosis (diagnostic yield: within vs adjacent to the lesion = 92.1% vs 60.0%, respectively; P = 0.004 and P = 0.003, respectively).
  
  
  CONCLUSIONS
  The combination of EBUS-GS and LungPoint was useful for diagnosing small PPL.
authors.affiliation: Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan. moto19781205@yahoo.co.jp
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tamiya
authors.forename: Norio
authors.initials: N
authors.lastname: Okamoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shiroyama
authors.forename: Naoko
authors.initials: N
authors.lastname: Morishita
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Emi
authors.initials: E
authors.lastname: Yoshida
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hirashima
authors.forename: Kunimitu
authors.initials: K
authors.lastname: Kawahara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawase
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D012984:Software; D014584:User-Computer Interface