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Original Research: INTERVENTIONAL PULMONOLOGY |

Factors Related to Diagnostic Sensitivity Using an Ultrathin Bronchoscope Under CT Guidance*

Naofumi Shinagawa, MD, PhD; Koichi Yamazaki, MD, PhD; Yuya Onodera, MD, PhD; Hajime Asahina, MD; Eiki Kikuchi, MD; Fumihiro Asano, MD, PhD; Kazuo Miyasaka, MD, PhD; Masaharu Nishimura, MD, PhD
Author and Funding Information

*From First Department of Medicine (Drs. Shinagawa, Yamazaki, Asahina, Kikuchi, and Nishimura) and Department of Radiology (Drs. Onodera and Miyasaka), Hokkaido University School of Medicine, Sapporo; and Department of Pulmonary Medicine and Interventional Bronchoscopy (Dr. Asano), Gifu Prefectural General Medical Center, Gifu, Japan.

Correspondence to: Koichi Yamazaki, MD, PhD, First Department of Medicine, Hokkaido University School of Medicine, North 15, West 7, Kitaku, Sapporo 060-8638, Japan; e-mail: kyamazak@med.hokudai.ac.jp



Chest. 2007;131(2):549-553. doi:10.1378/chest.06-0786
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Background: We investigated factors related to the diagnostic sensitivity of CT-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope and virtual bronchoscopy (VB) navigation for small peripheral pulmonary lesions.

Method: We have performed this procedure on 83 patients with 85 small peripheral pulmonary lesions (< 20 mm in diameter). We analyzed the relationship between the diagnostic sensitivity and the location of the lesions, the bronchial generation to which an ultrathin bronchoscope was inserted, and the lesion-bronchial and lesion-pulmonary arterial relationships on high-resolution CT.

Results: Fifty-six of the 85 lesions (66%) were diagnosed following CT-guided TBB using an ultrathin bronchoscope with VB navigation. The lesions located in the left superior segment of the lower lobe (S6) had a significantly low diagnostic sensitivity compared to other locations (p < 0.01). When an ultrathin bronchoscope could be inserted to the fifth or greater bronchial generation, the yield was above the average diagnostic sensitivity of 66%. Moreover, not only the patients with the presence of a bronchus leading directly to a lesion (CT-bronchus sign), but also the patients with the presence of a pulmonary artery leading to a lesion (CT-artery sign), had high diagnostic sensitivity (p < 0.01). Multivariate analysis revealed that the location of lesion was an independent predictor of diagnostic sensitivity (p < 0.05).

Conclusions: The location of the lesion, the bronchial generation to which an ultrathin bronchoscope was inserted, and the presence of a bronchus as well as a pulmonary artery leading to the lesion were valuable for predicting successful CT-guided TBB using an ultrathin bronchoscope with VB navigation.

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