title: Ultrathin Bronchoscopy with Multimodal Devices for Peripheral Pulmonary Lesions. A Randomized Trial.
abstract: BACKGROUND
  The combination of an ultrathin bronchoscope, navigational technology, and endobronchial ultrasound (EBUS) seems to combine the best of mutual abilities for evaluating peripheral pulmonary lesions, but ultrathin bronchoscopes that allow the use of EBUS have not been developed so far.
  
  
  OBJECTIVE
  To compare the diagnostic yield of transbronchial biopsy under EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance using a novel ultrathin bronchoscope with that using a thin bronchoscope with a guide sheath for peripheral pulmonary lesions.
  
  
  METHODS
  In four centers, patients with suspected peripheral pulmonary lesions less than or equal to 30 mm in the longest diameter were included and randomized to undergo transbronchial biopsy with EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance using a 3.0-mm ultrathin bronchoscope (UTB group) or a 4.0-mm thin bronchoscope with a guide sheath (TB-GS group).
  
  
  RESULTS
  A total of 310 patients were enrolled and randomized, among whom 305 patients (150, UTB group; 155, TB-GS group) were analyzed. The ultrathin bronchoscope could reach more distal bronchi than the thin bronchoscope (median fifth- vs. fourth-generation bronchi; P < 0.001). Diagnostic histologic specimens were obtained in 74% (42% for benign and 81% for malignant lesions) of the UTB group and 59% (36% for benign and 70% for malignant lesions) of the TB-GS group (P = 0.044, Mantel-Haenszel test). Complications including pneumothorax, bleeding, chest pain, and pneumonia occurred in 3% and 5% in the respective groups.
  
  
  CONCLUSIONS
  The diagnostic yield of the UTB method is higher than that of the TB-GS method. Clinical trial registered with www.umin.ac.jp/ctr/ (UMIN 000003177).
authors.affiliation: 1 Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Oki
authors.affiliation: 1 Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saka
authors.affiliation: 2 Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: 3 Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Asano
authors.affiliation: 4 Department of Chest Surgery and.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kurimoto
authors.affiliation: 5 Department of Surgery, Iwakuni Minami Hospital, Iwakuni, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Morita
authors.affiliation: 1 Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Chiyoe
authors.initials: C
authors.lastname: Kitagawa
authors.affiliation: 1 Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kogure
authors.affiliation: 6 Department of Pulmonary and Infectious Diseases, St. Marianna University School of Medicine, Kawasaki, Japan; and.
authors.forename: Teruomi
authors.initials: T
authors.lastname: Miyazawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000295:instrumentation*; D019160:Endosonography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000295:instrumentation*
keywords: EBUS; bronchoscopy; lung cancer; navigation; solitary pulmonary nodule