title: Computed tomography-guided bronchoscopy in the diagnosis of small peripheral pulmonary lesions: A retrospective study of 240 examinations in a single academic center.
abstract: BACKGROUND
  Factors that affect the diagnostic yield in computed tomography (CT)-guided bronchoscopy have not yet been fully evaluated. To improve the diagnostic yield of peripheral pulmonary lesions (PPLs) by CT-guided bronchoscopy, we quantitatively analyzed factors affecting the diagnostic yield.
  
  
  METHODS
  The data were collected for 240 PPLs in 237 patients examined by using CT-guided bronchoscopy between October 2003 and November 2011 in our respiratory center. The association of diagnostic yield with the CT bronchus sign (CT-BS), lesion size, location, number of tissue specimens, and type of bronchoscope was retrospectively assessed.
  
  
  RESULTS
  The diagnostic yield of PPLs with negative CT-BS was significantly lower (2.9%) than that for PPLs with positive CT-BS (52.2%; p<0.01). Among the PPLs with positive CT-BS, the yield was significantly higher in those in the left S(3) than for lesions in other bronchial segments (83.3% vs. 50.3%; p<0.05). Lesion size was not significantly associated with diagnostic yield. The yield was significantly lower in PPLs without lung tissue specimens than in lesions with biopsy specimens (p<0.01). Moreover, a thin bronchoscope produced a higher yield in comparison with other bronchoscope types (66.0% vs. 47.6%; p<0.05). Multivariate analysis revealed that the number of biopsy specimens was an independent factor affecting diagnostic yield.
  
  
  CONCLUSIONS
  CT-guided bronchoscopy is valuable in the diagnosis of PPLs with positive CT-BS regardless of lesion size; however, PPLs with negative CT-BS are not good candidates for CT-guided bronchoscopy. Obtaining tissue specimens by biopsy is a critical factor in diagnosing PPLs.
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: yanomura@shinshu-u.ac.jp.
authors: Yayoi
authors: Y
authors: Tokoro
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: yasumasa@shinshu-u.ac.jp.
authors: Masanori
authors: M
authors: Yasuo
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: takob@shinshu-u.ac.jp.
authors: Takashi
authors: T
authors: Kobayashi
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: mineyuki@shinshu-u.ac.jp.
authors: Mineyuki
authors: M
authors: Hama
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: ichiyama@shinshu-u.ac.jp.
authors: Takashi
authors: T
authors: Ichiyama
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: toshih@shinshu-u.ac.jp.
authors: Toshimichi
authors: T
authors: Horiuchi
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: atsuhito@shinshu-u.ac.jp.
authors: Atsuhito
authors: A
authors: Ushiki
authors: Department of Radiology, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: kawasato@shinshu-u.ac.jp.
authors: Satoshi
authors: S
authors: Kawakami
authors: Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: thondat@shinshu-u.ac.jp.
authors: Takayuki
authors: T
authors: Honda
authors: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 3908621, Japan. Electronic address: masayuki@shinshu-u.ac.jp.
authors: Masayuki
authors: M
authors: Hanaoka
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Bronchoscopy; CT-guided bronchoscopy; CT-guided transbronchial biopsy; Diagnostic sensitivity; Small peripheral pulmonary lesion