Diagnostic utility of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without fluoroscopic monitoring

Abstract

Objective To evaluate the feasibility and safety of endobronchial ultrasonography (EBUS) with a guide sheath (EBUS-GS) in the diagnosis of peripheral pulmonary lesions (PPLs) without fluoroscopic monitoring. Methods We performed a retrospective analysis of 52 patients with PPLs who underwent EBUS-GS at Peking University Cancer Hospital from March 2016 to February 2017. Their clinicopathologic data and complications were assessed. According to diagnostic ratio, categorical data are presented as frequencies and were analyzed using the chi-square test. Results There were 26 men and 26 women in this group, with a mean age of 55.6±10.0 years (range, 22-78 years). A total of 52 PPLs were examined, of which 47 could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 75.0% (39/52). The diagnostic yield for malignancy was higher than that for benign lesions (82.2% vs 28.6%, χ2=6.658, P=0.010). The combination of transbronchial lung biopsy, brush smear, and bronchoalveolar lavage fluid provided higher diagnostic yield than any singer way (80.4% vs 33.3%, χ2=4.019, P=0.045). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesion (85.3% vs 55.6%, χ2=4.078, P=0.043) and PPLs located in the central two-thirds of the lung (86.1% vs 50.0%, χ2=5.898, P=0.015). There was no significant difference in the diagnosis rate among lung lobes and lesion sizes measured by CT, and the learning curve also had no significant impact on the diagnosis rate. One (1.9%) patient suffered from intraoperative bleeding which could be managed under endoscopy. Seven (13.5%) patients had transient hypoxemia during surgery, which was relieved after improving the nasal catheter oxygen flow. Twenty-two (42.3%) patients had a small amount of bloody sputum within 24 h after surgery, but no special treatments were needed. Conclusion EBUS-GS without fluoroscopic monitoring for PPLs is an effective and safe procedure. Key words: Pulmonary peripheral lesions; Bronchoscopy; Ultrasonography; Virtual bronchoscopy