title: Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.
abstract: BACKGROUND
  Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported.
  
  
  METHODS
  We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique.
  
  
  RESULTS
  Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last.
  
  
  CONCLUSIONS
  Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources.
authors.affiliation: Department of Internal Medicine, Ospedale Civico di Lugano, Lugano, Suiza.
authors.forename: Alessio
authors.initials: A
authors.lastname: Casutt
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausana, Suiza.
authors.forename: Maura
authors.initials: M
authors.lastname: Prella
authors.affiliation: Department of Radiology, University Hospital of Lausanne, Lausana, Suiza.
authors.forename: Catherine
authors.initials: C
authors.lastname: Beigelman-Aubry
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausana, Suiza.
authors.forename: Jean-William
authors.initials: JW
authors.lastname: Fitting
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausana, Suiza.
authors.forename: Laurent
authors.initials: L
authors.lastname: Nicod
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausana, Suiza.
authors.forename: Angela
authors.initials: A
authors.lastname: Koutsokera
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausana, Suiza. Electronic address: alban.lovis@chuv.ch.
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D044963:Biopsy, Fine-Needle / Q000295:instrumentation / Q000379:methods; D001999:Bronchoscopy / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005471:Fluoroscopy / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D059032:Learning Curve; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: bronchoscopy; broncoscopia; ecografía endobronquial con sonda radial; lesiones pulmonares periféricas; peripheral pulmonary lesion; radial probe endobronchial ultrasound