SESSION TITLE: Bronchoscopy and Interventional Procedures
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) have been reported to enhance the diagnostic accuracy of bronchoscopy for peripheral pulmonary lesions. The combination of thinner bronchoscopes and navigational technology seems to make the best of mutual abilities, but ultrathin bronchoscopes which allow the use of EBUS have not been developed so far. The purpose of the present study was to compare the diagnostic yields of transbronchial biopsy (TBB) under EBUS, fluoroscopy and VBN guidance using a novel ultrathin bronchoscope and a thin bronchoscope with a guide sheath (GS) for peripheral pulmonary lesions.
METHODS: In four centers, a total of 310 patients with suspected peripheral lesions ≤ 30 mm in the longest diameter on CT were included and randomized to undergo TBB with EBUS, fluoroscopy and VBN guidance using a 3.0-mm ultrathin bronchoscope (UTB group) or a 4.0-mm thin bronchoscope with a guide sheath (TB-GS group). Except for the bronchoscopes and a guide sheath, the same type devices or instruments such as a 1.4-mm radial ultrasonic probe and biopsy forceps were used in both groups.
RESULTS: A total of 310 patients were enrolled and randomized, among whom 305 patients (150, UTB group; 155, TB-GS group) were included in the analysis. Median lesion size in the longest diameter was 18.8 mm in UTB group and 19.4 mm in TB-GS group. Diagnostic histologic specimens were obtained in 73% (37% for benign and 82% for malignant lesions) of UTB group and 60% (33% for benign and 73% for malignant lesions) of TB-GS group (p = 0.01). Complications including pneumothorax, bleeding, chest pain and pneumonia occurred in 3% and 5% in the respective groups.
CONCLUSIONS: The diagnostic yield of the UTB method is higher than that of the TB-GS method.
CLINICAL IMPLICATIONS: Ultrathin bronchoscopy under EBUS, fluoroscopy and VBN guidance provides a high diagnostic yield for small peripheral pulmonary lesions.
DISCLOSURE: The following authors have nothing to disclose: Masahide Oki, Hideo Saka, Masahiko Ando, Noriaki Kurimoto, Katsuhiko Morita, Fumihiro Asano, Chiyoe Kitagawa, Yoshihito Kogure, Teruomi Miyazawa
We used prototype ultrathin bronchoscopes, which were loaned to the authors by Olympus, Tokyo, Japan.