Sonographic characteristics upon endobronchial ultrasonography with a guide sheath (EBUS-GS) are useful for diagnosing pulmonary peripheral lesions

Abstract

Introduction: The usefulness of bronchoscopy using endobronchial ultrasonography with a guide sheath (EBUS-GS) in locating pulmonary peripheral lesions (PPLs) has recently been established. However,it is not clear whether the sonographic characteristics upon bronchoscopy with EBUS-GS are useful for diagnosis. We examined the diagnostic value of these characteristics. Patients and Methods: This retrospective observational study included patients who were suspected of having malignant or benign PPLs and underwent bronchoscopy with EBUS-GS at our hospital between April 2012 and July 2014. Sonographic features such as echogenicity (heterogeneous or homogeneous, hypoechoic, hyperechoic or isoechoic) were recorded. Results: During the study period, 480 patients underwent bronchoscopy. Of these, 118 (118/480; 24.6%) underwent bronchoscopy with EBUS-GS. In 99 patients (within, 77+; adjacent to, 22) we were able to observe sonographic images. In 64 of these patients (primary lung cancer, 61; metastatic lung cancer, 3) we diagnosed thoracic malignancies (group A), whereas in 35 we diagnosed benign diseases (group B: nontuberculous mycobacteriosis, 11; organizing pneumonia, 4; pulmonary fungus infection, 3; lung abscess, 3; pulmonary tuberculosis, 2; other diseases, 12). The sonographic features tended to be homogeneous and hypoechoic in the order of lung abscess, group A, and group B other than lung abscess. Conclusions: Sonographic homogeneity and hypoechoicity of PPLs on EBUS-GS are specific for lung abscess. The sonographic features of PPLs as determined by EBUS-GS are useful for both location of PPLs and qualitative diagnosis.