PURPOSE: Even though fluoroscopy-guided bronchoscopy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. This study compared the diagnostic performance of bronchoscopy under both EBUS and fluoroscopy guidance with fluoroscopy-guided bronchoscopy in PPLs.
METHODS: A retrospective study was conducted on 92 patients who were diagnosed with PPLs and underwent either EBUS plus fluoroscopy-guided or fluoroscopy-guided bronchoscopy between June 2009 and March 2011. The diagnostic yields of both modalities were calculated.
RESULTS: The mean diameter of the PPLs measured by computed tomography of the chest was 24.0±8.9 millimeters. The overall diagnostic yield was 66.3% and EBUS plus fluoroscopy group showed more favorable diagnostic performance than fluoroscopy-guided group (78.0% and 56.9%, respectively; p = 0.03). Subgroup analysis demonstrated, for PPLs greater than 20 millimeters (n = 54), EBUS plus fluoroscopy guidance did not render different accurate yield from the other technique (81.8% vs. 71.9%; p = 0.40). However, in 38 patients who had lesions less than 20 millimeters, EBUS plus fluoroscopy-guided bronchoscopy provided higher diagnostic yield significantly (73.7% vs. 31.6%; p = 0.009).
CONCLUSIONS: Bronchoscopy under EBUS and fluoroscopy guidance improved the diagnostic yield of PPLs, especially those smaller than 20 millimeters in diameter.
CLINICAL IMPLICATIONS: To enhance bronchoscopic diagnosis of PPLs less than 20 millimeters, EBUS plus fluoroscopy guidance should be considered.
DISCLOSURE: The following authors have nothing to disclose: Viboon Boonsarngsuk, Pensupa Raweelert, Sabaithip Juthakarn
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