title: Evaluation of Pulmonary Nodules Using the Spyglass Direct Visualization System Combined With Radial Endobronchial Ultrasound: A Clinical Feasibility Study.
abstract: BACKGROUND
  Sampling of peripheral pulmonary nodules with radial endobronchial ultrasound (p-EBUS) increases diagnostic yield of bronchoscopy. However, diagnostic yield is influenced by numerous factors.
  
  
  OBJECTIVE
  We evaluated the use of SpyGlass, a one millimeter diameter optic fiber, to obtain images of the distal mucosa and of pulmonary lesions detected with p-EBUS to determine if visual aspect of the distal mucosa was predictive of diagnosis.
  
  
  METHODS
  We prospectively recruited subjects investigated for peripheral nodules. Bronchoscopy was performed and p-EBUS was used to locate the lesion through a guide sheath. The Spyglass fiber was introduced in the sheath to obtain images of the distal bronchial mucosa. Tissue sampling was subsequently done.
  
  
  RESULTS
  Fifteen patients were enrolled in the study. A final diagnosis of malignancy was confirmed in 80%. All lesions could be located using p-EBUS (100%). Diagnostic sensitivity for p-EBUS was 58.3%. Distal mucosa could be imaged with SpyGlass in 14/15 patients (93.3%). Mucosal appearance was described as abnormal in 7 out of the 15 subjects. Mean SpyGlass procedure time was 6.5 minutes. No direct complication was reported.
  
  
  CONCLUSIONS
  Spyglass can be used in combination with p-EBUS to obtain images of the distal bronchial mucosa and peripheral pulmonary nodules. More patients will be needed to confirm whether mucosal appearance can be predictive of malignancy.
authors.affiliation: Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors.forename: Krystelle
authors.initials: K
authors.lastname: Godbout
authors.affiliation: Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Martel
authors.affiliation: Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Simon
authors.affiliation: Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors.forename: Noël
authors.initials: N
authors.lastname: Lampron
authors.affiliation: Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada.
authors.forename: Antoine
authors.initials: A
authors.lastname: Delage
keywords: Bronchoscopy; Endobronchial ultrasound; Lung cancer; Optic fiber; Peripheral nodule