title: Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study.
abstract: BACKGROUND
  Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions. In some cases, however, it is difficult to obtain adequate biopsy samples for pathological diagnosis. Adequate prediction of the diagnostic accuracy of TBB with EBUS-GS is important before deciding whether bronchoscopy should be performed.
  
  
  METHODS
  We retrospectively reviewed 149 consecutive patients who underwent TBB with EBUS-GS for small-sized peripheral lung lesions (≤30 mm in diameter) from April 2012 to March 2013. We conducted an exploratory analysis to identify clinical factors that can predict an accurate diagnosis by TBB with EBUS-GS. All patients underwent thin-section chest computed tomography (CT) scans (0.5-mm slices), and the CT bronchus sign was evaluated before bronchoscopy in a group discussion. The final diagnoses were pathologically or clinically confirmed in all studied patients (malignant lesions, 110 patients; benign lesions, 39 patients).
  
  
  RESULTS
  The total diagnostic yield in this study was 72.5% (95% confidence interval: 64.8-79.0%). Lesion size, lesion visibility on chest X-ray, and classification of the CT bronchus sign were factors significantly associated with the definitive biopsy result in the univariate analysis. In the multivariate analysis, only the CT bronchus sign remained as a significant predictive factor for successful bronchoscopic diagnosis. The CT bronchus sign was also significantly associated with the EBUS findings of the lesions.
  
  
  CONCLUSIONS
  Our results suggest that the CT bronchus sign is a powerful predictive factor for successful TBB with EBUS-GS.
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. minezawa@fujita-hu.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Minezawa
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. misonikomiudontenmusu@yahoo.co.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Okamura
authors.affiliation: Department of Public Health, Fujita Health University, Toyoake, Aichi, Japan. yatsuya@fujita-hu.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.affiliation: Laboratory of Molecular Biology & Histochemistry, Fujita Health University, Toyoake, Aichi, Japan. naokiy@fujita-hu.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. 81013039@fujita-hu.ac.jp.
authors.forename: Sayako
authors.initials: S
authors.lastname: Morikawa
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. teperou@cameo.plala.or.jp.
authors.forename: Teppei
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. marimo087@yahoo.co.jp.
authors.forename: Mariko
authors.initials: M
authors.lastname: Morishita
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. denpaneko@hotmail.com.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Niwa
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. violet.essence.09.24@hotmail.co.jp.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takeyama
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. mienon@fujita-hu.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Mieno
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. tami@fujita-hu.ac.jp.
authors.forename: Tami
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. suozu@med.nagoya-u.ac.jp.
authors.forename: Sakurako
authors.initials: S
authors.lastname: Uozu
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. gotoyasu510@hotmail.com.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. michi@fujita-hu.ac.jp.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. isogai@fujita-hu.ac.jp.
authors.forename: Sumito
authors.initials: S
authors.lastname: Isogai
authors.affiliation: Department of Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Japan. matsuo.rem@chubuh.rofuku.go.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Matsuo
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. me362111@s.okadai.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. hashinao@med.nagoya-u.ac.jp.
authors.forename: Naozumi
authors.initials: N
authors.lastname: Hashimoto
authors.affiliation: Department of Respiratory Medicine, Daiyu-kai Hospital, Ichinomiya, Aichi, Japan. mokazawa@fujita-hu.ac.jp.
authors.forename: Mitsushi
authors.initials: M
authors.lastname: Okazawa
authors.affiliation: Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. jeanluc@fujita-hu.ac.jp.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Imaizumi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001995:Bronchography / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*