Comparison between thick and thin bronchoscopes for diagnosis of peripheral pulmonary lesions

Abstract

Background and Aim There are uncertainties about the strategies for selecting the size of bronchoscopes when approaching peripheral pulmonary lesions (PPLs). This study aimed to compare the circumstances at which thick and thin scopes were used and to determine the optimal approach for better diagnostic yield. Methods This was a retrospective review of patients who underwent bronchoscopy for PPLs with thick (1T240, 1T260 or 1TQ290) or thin (P260 or P290) Olympus bronchoscopes at our hospital from April 2011 to December 2014. By logistic regression analysis, diagnostic yields were compared between thick and thin bronchoscopes. Results A total of 121 patients with median age of 69 years (range 20–94) were included. The thick bronchoscope group (n=67) and the thin bronchoscope group (n=54) were similar in terms of age, sex, and shape and location of PPLs, but not the size of PPLs. Adjusting for the use of EBUS-GS (endobronchial ultrasound with guide sheath) and virtual bronchoscopic navigation, and PPL size, the diagnostic yields tended to be higher in the thick group (79.1%, 53/67) compared with the thin group (59.3%, 32/54) (OR, 1.77; 95% CI, 0.68 to 4.56; p=0.24). There were no significant differences in the diagnostic yield for PPLs at upper lobe (74.4% vs 67.6%, p=0.615), but the thick group had significantly higher diagnostic yields for PPLs at lower lobe compared to the thin group, (84.6% vs 43.8%, p=0.014). When EBUS findings were adjacent to or invisible, there were significant differences between them (75.0% vs 46.2%, p=0.0498). Conclusions For the PPLs which are located at lower lobe, or if a probe cannot display a within position, we should use thick bronchoscopes aggressively.