title: Role of ultrasound-guided transbronchial biopsy in the diagnosis of peripheral pulmonary lesions.
abstract: BACKGROUND
  Endobronchial ultrasound (EBUS) can be used as an alternative to fluoroscopy to visualize a peripheral pulmonary lesion (PPL) and to provide an image guidance for transbronchial biopsy (TBB). The aim of this study was to verify the accuracy of EBUS-guided TBB in the diagnosis of PPLs.
  
  
  METHODS
  All the patients with CT-scan evidence of PPL who underwent bronchoscopy with EBUS in the period between 2008 and 2011 were retrospectively evaluated. EBUS was performed using a radial-type miniature ultrasound probe. Once obtained an EBUS image of the PPL, we measured the distance of the PPL from the outer orifice of the working channel of the bronchoscope in order to perform TBB at PPL site.
  
  
  RESULTS
  A total of 662 patients were examined. The mean diameter of lesions was 36 ± 20 mm. PPLs were visualized in 494 patients (75%) and the TBB was performed in 479 patients. Thirty-two patients were lost in follow-up and data from 447 patients were analyzed. TBB results were 255 cancers and 192 non-malignant lesions. The final diagnosis reported was 359 cases of cancer and 88 of benign lesion. EBUS-guided TBB had a sensitivity of 71% for the diagnosis of cancer, a negative predictive value of 46% and an overall diagnostic accuracy of 77%.
  
  
  CONCLUSIONS
  These data obtained from a large series of patients and using an original method show that EBUS represents a valid support to bronchoscopy and that the EBUS-guided TBB has a high diagnostic yield in the diagnosis of PPLs.
authors: Pulmonary Medicine Unit, Università Cattolica del Sacro Cuore, University Hospital A. Gemelli, Rome, Italy. leofuso@rm.unicatt.it
authors: Leonello
authors: L
authors: Fuso
authors: Francesco
authors: F
authors: Varone
authors: Daniele
authors: D
authors: Magnini
authors: Fabiana
authors: F
authors: Baldi
authors: Guido
authors: G
authors: Rindi
authors: Gabriella
authors: G
authors: Pagliari
authors: Riccardo
authors: R
authors: Inchingolo
authors: Andrea
authors: A
authors: Smargiassi
mesh_terms: D001999:Bronchoscopy / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008171:Lung Diseases / Q000175:diagnosis* / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity