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Eur Respir J 2004; 24:533-537
Copyright ©ERS Journals Ltd 2004

Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions

E. Kikuchi1, K. Yamazaki1, N. Sukoh2, J. Kikuchi1, H. Asahina1, M. Imura1, Y. Onodera3, N. Kurimoto4, I. Kinoshita1 and M. Nishimura1

1 First Dept of Medicine, Hokkaido University School of Medicine, Sapporo, 2 Dept of Medicine, Iwamizawa Municipal General Hospital, Iwamizawa, and 3 Dept of Radiology, Hokkaido University School of Medicine, and 4 Dept of Surgery, National Hiroshima Hospital, Higashi-Hiroshima, Japan.

CORRESPONDENCE: K. Yamazaki, First Dept of Medicine, Hokkaido University School of Medicine, North 15, West 7, Kitaku, Sapporo, 060-8638, Japan. Fax: 81 117067899. E-mail: kyamazak@med.hokudai.ac.jp

Keywords: Bronchial brushing cytology, endobronchial ultrasonography, guide-sheath, peripheral pulmonary lesion, primary lung cancer, transbronchial biopsy

Received: December 15, 2003
Accepted June 23, 2004

The usefulness of endobronchial ultrasonography (EBUS) with guide-sheath (GS) as a guide for transbronchial biopsy (TBB) for diagnosing peripheral pulmonary lesions (PPL)s and for improving diagnostic accuracy was evaluated in this study.

EBUS-GS-guided TBB was performed in 24 patients with 24 PPLs of ≤30 mm in diameter (average diameter=18.4 mm). A 20-MHz radial-type ultrasound probe, covered with GS was inserted via a working bronchoscope channel and advanced to the PPL in order to produce an EBUS image. The probe with the GS was confirmed to reach the lesion by EBUS imaging and X-ray fluoroscopy. When the lesion was not identified on the EBUS image, the probe was removed and a curette was used to lead the GS to the lesion. After localising the lesion, the probe was removed, and TBB and bronchial brushing were performed via the GS.

Nineteen peripheral lesions (79.2%) were visualised by EBUS. All patients whose PPLs were visible on EBUS images subsequently underwent an EBUS-GS-guided diagnostic procedure. A total of 14 lesions (58.3%) were diagnosed. Even when restricted to PPLs <20 mm in diameter, the diagnostic sensitivity was 53%.

In conclusion, endobronchial ultrasonography with guide sheath-guided transbronchial biopsy was feasible and effective for diagnosing peripheral pulmonary lesions.




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