title: Additional transbronchial needle aspiration through a guide sheath for peripheral pulmonary lesions that cannot be detected by radial EBUS.
abstract: BACKGROUND
  Endobronchial ultrasound with a guide sheath (EBUS-GS) has resulted to better diagnostic outcome for peripheral pulmonary lesions (PPLs), although the yield is not satisfactory for lesions that cannot be located by EBUS. We aimed to evaluate whether the addition of a new technique, transbronchial needle aspiration through a guide sheath (GS-TBNA), can increase the yield for these cases.
  
  
  METHODS
  This was a retrospective review of cases that were not located by EBUS during EBUS-GS for PPL diagnosis. From September 2012 to August 2014, 67 PPLs had 'invisible' EBUS-GS location prior to transbronchial sampling. The patients were divided into two groups according to the use of additional GS-TBNA: GS-TBNA group (n=22) and non-GS-TBNA group (n=45). Diagnostic yields were compared and multivariate analysis was performed to determine the factors associated with increased diagnostic yield.
  
  
  RESULTS
  The diagnostic yield was significantly higher in the GS-TBNA group than in the non-GS-TBNA group (54.5% vs 17.8%, P<0.01). The complication rate was not significantly different between the GS-TBNA group and the non-GS-TBNA group (0% vs 4.4%, P=1.0). Multivariate analysis showed that only performing GS-TBNA was significantly associated with increased diagnostic yield (odds ratio 3.99, P=0.03).
  
  
  CONCLUSIONS
  GS-TBNA is a safe technique for PPL diagnosis and may be useful when the EBUS probe cannot reach the lesion.
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hayama
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Izumo
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Christine
authors.initials: C
authors.lastname: Chavez
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tsuchida
authors.affiliation: Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000000981:diagnostic imaging* / Q000473:pathology*; D001999:Bronchoscopy / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation* / Q000379:methods; D019160:Endosonography / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: EBUS-GS; GS-TBNA; peripheral pulmonary lesion; radial EBUS; transbronchial needle aspiration