Endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions. A controlled study with fluoroscopy.
BACKGROUND
Fluoroscopy-guided bronchoscopy is usually performed for the diagnosis of peripheral pulmonary lesions (PPL), but the diagnostic yield varies widely among studies. Endobronchial ultrasound (EBUS) can increase the diagnostic yield of bronchoscopic diagnosis of PPL.


OBJECTIVE
To compare the diagnostic yield of fluoroscopy-guided bronchoscopy and EBUS with fluoroscopy-guided bronchoscopy in the study of PPL.


METHODS
All patients who underwent bronchoscopy to study PPL from January 2009 to December 2012 were prospectively included. 145 consecutive patients were randomly distributed in two groups: EBUS and fluoroscopy (50 patients, 71.3 ± 8.2 years) or fluoroscopy alone (95 patients, 68 ± 10.5 years). The mean diameter of the lesions was 41.97 ± 19.22 mm. Cytological brushing and transbronchial biopsies were obtained. All procedures were performed under fluoroscopic guidance with intravenous conscious sedation. EBUS was performed using an endoscopic ultrasound system equipped with a 20-MHz radial miniprobe introduced via a guide-sheath. Bronchoscopist, cytologist, study protocol, techniques and tools were the same throughout the whole study.


RESULTS
129 (89%) patients had malignant disease. A diagnosis with bronchoscopy was established in 105 (72.4%) patients. EBUS plus fluoroscopy obtained a diagnostic yield in 78% of patients and fluoroscopy alone in 69.5% (non-significant). In contrast, for lesions smaller than 30 mm, EBUS plus fluoroscopy guidance provided significantly greater diagnostic performance than fluoroscopy alone (90 vs. 52%; P=.05).


CONCLUSIONS
Bronchoscopy under EBUS plus fluoroscopy guidance is a technique that has become useful for the diagnostic of LPPs, especially those smaller than 30 mm in diameter.
Servei de Pneumologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), ISCIII, Barcelona, España. Electronic address: sanchezfont@msn.com.
Albert
A
Sánchez-Font
Servei de Pneumologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), ISCIII, Barcelona, España.
Laia
L
Giralt
Servei de Radiologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, Barcelona, España.
Ivan
I
Vollmer
Servei d'Anatomia Patològica, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, Barcelona, España.
Lara
L
Pijuan
Servei de Pneumologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), ISCIII, Barcelona, España.
Joaquim
J
Gea
Servei de Pneumologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), ISCIII, Barcelona, España.
Víctor
V
Curull
D000368:Aged; D001999:Bronchoscopy; D019160:Endosonography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis*; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies
Cáncer de pulmón; Endobronchial ultrasound; Lesiones pulmonares periféricas; Lung cancer; Nódulo pulmonar solitario; Peripheral pulmonary lesions; Solitary pulmonary nodule; Ultrasonografía endobronquial radial