PURPOSE: To evaluate the clinical benefits of ultrathin bronchoscope in the pathological diagnosis of peripheral lung lesions.
METHODS: From March 2000 to March 2005, we routinely used a 2.8-mm outer diameter ultrathin bronchoscope (BF-XP260F; Olympus Co., Tokyo) for the peripheral lesions with fluoroscopic guidance. A retrospective analysis was performed on the pathological diagnoses, their accuracy, the optimal number of biopsy specimens, and complications. In 399 patients (pts), 54 were neglected because of central lesions (30), bronchoscopic re-examinations (23), and pneumothorax before biopsy (1). 345 pts (male 234, female 111, mean age 64.3 years) of initial examinees were studied. The minimal follow-up was 1 year in the final diagnosis of benign diseases.
RESULTS: In the final diagnoses of 209 malignancies, 132 pts (63%) obtained their results at first examinations. Bronchial visual abnormalities were observed in 44 pts (21%) more peripherally beyond sub-segmental bronchi, and biopsies were positive in 37 pts (18%). The diagnostic rates were not different as to the size of the tumor (63% when 2.0 cm or less in diameter, 63% when more than 2.0 cm). We have tried to obtain 10 biopsy specimens. The diagnostic rate was 46% at the first biopsy, and reached 90% cumulatively on the 6th attempt. In the final diagnoses of 105 benign lesions, 41 pts (39%) received pathological diagnosis at the first bronchoscopy (granuloma 15, inflammation 9, tuberculoma 9, aspergillosis 5, non-tuberculous mycobacteriosis 2, cryptococcosis 1). Pneumothorax was experienced in 6 pts (1.5%). All improved by observation only (4) or by tube drainage (2). In 2 pts, ultrathin scope penetrated visceral pleura. No major bleeding was observed.
CONCLUSION: Ultrathin bronchoscopy is a safe and reliable method to obtain the pathological specimen in the diagnosis of peripheral lesions under fluoroscopic guidance. Pneumothorax was the only complication so far.
CLINICAL IMPLICATIONS: Ultrathin bronchoscopy may be the procedure of choice for peripheral lesions.
DISCLOSURE: Hideo Saka, Consultant fee, speaker bureau, advisory committee, etc, Advisory committee.