Masahide Oki1, Hideo Saka2, Tatsuya Imabayashi3, Daisuke Himeji4, Yoichi Nishii5, Harunori Nakashima6, Daisuke Minami7, Shotaro Okachi8, Yasuyuki Mizumori9, Masahiko Ando10. 1. Dept of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan masahideo@aol.com. 2. Dept of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 3. Dept of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 4. Dept of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan. 5. Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan. 6. Dept of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan. 7. Dept of Respiratory Medicine, Okayama Medical Center, Okayama, Japan. 8. Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. 9. Dept of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji, Japan. 10. Dept of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan.
Abstract
BACKGROUND: Guide sheaths (GSs) have been widely used during radial probe endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) of peripheral pulmonary lesions. However, it remains unknown whether a GS enhances the diagnostic yield. We compared the diagnostic yields of small peripheral pulmonary lesions between rEBUS-TBB with and without a GS. METHODS: In eight institutions, patients with peripheral pulmonary lesions ≤30 mm in diameter were enrolled and randomised to undergo rEBUS-TBB with a GS (GS group) or without a GS (non-GS group) using a 4.0-mm thin bronchoscope, virtual bronchoscopic navigation and fluoroscopy. The primary end-point was the diagnostic yield of the histology specimens. RESULTS: A total of 605 patients were enrolled; ultimately, data on 596 (300 in the GS group and 296 in the non-GS group) with peripheral pulmonary lesions having a longest median diameter of 19.6 mm were analysed. The diagnostic yield of histological specimens from the GS group was significantly higher than that from the non-GS group (55.3% versus 46.6%; p=0.033). Interactions were evident between the diagnostic yields, procedures, lobar locations (upper lobe versus other regions; p=0.003) and lesion texture (solid versus part-solid nodules; p=0.072). CONCLUSIONS: The diagnostic yield for small peripheral pulmonary lesions afforded by rEBUS-TBB using a GS was higher than that without a GS.
BACKGROUND: Guide sheaths (GSs) have been widely used during radial probe endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) of peripheral pulmonary lesions. However, it remains unknown whether a GS enhances the diagnostic yield. We compared the diagnostic yields of small peripheral pulmonary lesions between rEBUS-TBB with and without a GS. METHODS: In eight institutions, patients with peripheral pulmonary lesions ≤30 mm in diameter were enrolled and randomised to undergo rEBUS-TBB with a GS (GS group) or without a GS (non-GS group) using a 4.0-mm thin bronchoscope, virtual bronchoscopic navigation and fluoroscopy. The primary end-point was the diagnostic yield of the histology specimens. RESULTS: A total of 605 patients were enrolled; ultimately, data on 596 (300 in the GS group and 296 in the non-GS group) with peripheral pulmonary lesions having a longest median diameter of 19.6 mm were analysed. The diagnostic yield of histological specimens from the GS group was significantly higher than that from the non-GS group (55.3% versus 46.6%; p=0.033). Interactions were evident between the diagnostic yields, procedures, lobar locations (upper lobe versus other regions; p=0.003) and lesion texture (solid versus part-solid nodules; p=0.072). CONCLUSIONS: The diagnostic yield for small peripheral pulmonary lesions afforded by rEBUS-TBB using a GS was higher than that without a GS.