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Bronchoscopy |

Endobronchial Ultrasonography Using a Guide Sheath Increases the Ability To Diagnose Peripheral Pulmonary Lesions Endoscopically*

Noriaki Kurimoto, MD; Teruomi Miyazawa, MD, FCCP; Seiji Okimasa, MD; Akihiro Maeda, MD, FCCP; Hiroshi Oiwa, MD; Yuka Miyazu, MD; Masaki Murayama, MD
Author and Funding Information

*From the Departments of Thoracic Surgery (Drs. Kurimoto and Okimasa) and Respiratory Medicine (Drs. Maeda and Oiwa), National Hiroshima Hospital, Hiroshima; Department of Respiratory Medicine (Drs. Miyazawa and Miyazu), Hiroshima City Hospital, Hiroshima; and Department of Surgery (Dr. Murayama), Iwakuni Minami Hospital, Iwakuni, Japan.

Correspondence to: Noriaki Kurimoto, MD, 513 Jike, Saijyoucyou, Higashi-hiroshima City, Hiroshima Prefecture, 739-0041 Japan; e-mail; n.kurimoto@do7.enjoy.ne.jp



Chest. 2004;126(3):959-965. doi:10.1378/chest.126.3.959
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Study objective: To assess the ability of endobronchial ultrasonography (EBUS) using a guide sheath (EBUS-GS) to diagnose peripheral pulmonary lesions.

Method: We devised a technique for EBUS-GS covering a miniature probe, and 150 lesions were evaluated in a prospective open study. In this procedure, the probe covered by a guide sheath is introduced into the lesion via the working channel of a bronchoscope. The probe is withdrawn, while the guide sheath is left in situ. A brush or biopsy forceps is introduced through the guide sheath into the lesion.

Results: One hundred sixteen of 150 EBUS-GS procedures (77%) were diagnostic. Cases in which the probe was located within the lesion had a significantly higher diagnostic yield (105 of 121 cases, 87%) than when the probe was located adjacent to it (8 of 19 cases, 42%) [p < 0.0001, χ2]. The diagnostic yield from EBUS-GS in lesions ≤ 10 mm (16 of 21 lesions, 76%), >10 to ≤ 15 mm (19 of 25 lesions, 76%; p = 0.99, χ2), >15 to ≤ 20 mm (23 of 35 lesions, 66%; p = 0.41, χ2), and > 20 to ≤ 30 mm (33 of 43 lesions, 77%; p = 0.96, χ2) were similar, demonstrating the efficacy of EBUS-GS even in lesions ≤ 10 mm in diameter. In 54 of 81 lesions ≤ 20 mm, fluoroscopy was not able to confirm whether the forceps reached the lesion. However, the yield was the same with (67%, 18 of 27 lesions) and without (74%, 40 of 54 lesions) successful fluoroscopy (p = 0.96, χ2). Moderate bleeding occurred in two patients (1%); there were no other complications.

Conclusions: EBUS-GS is a useful method for collecting samples from peripheral pulmonary lesions, even those too small to be visualized under fluoroscopy.

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