Original article
General thoracic
Endobronchial Ultrasonography With a Guide Sheath in the Diagnosis of Benign Peripheral Diseases

https://doi.org/10.1016/j.athoracsur.2011.11.073Get rights and content

Background

For appropriate treatment, such as the selection of antibiotics or initiation of steroid therapy, correctly diagnosing benign pulmonary diseases located at the periphery is vital. This study assessed the usefulness of bronchoscopy using endobronchial ultrasonography with a guide sheath (EBUS-GS) in the diagnosis of benign pulmonary diseases, especially those presenting peripheral nodular lesions.

Methods

We retrospectively reviewed 159 patients with 171 peripheral pulmonary lesions (PPLs) that were subsequently diagnosed as benign diseases. To examine the role of bronchoscopy with EBUS-GS, the contribution of bronchoscopy was classified into 4 categories. We also retrospectively reviewed 24 patients with 25 PPLs that were subsequently diagnosed as benign diseases by bronchoscopy without EBUS-GS (historical control).

Results

The ultimate diagnosis of 171 PPLs included 45 cases of mycobacteriosis, 45 cases of bronchiolitis obliterans organizing pneumonia/chronic organized pneumonia (BOOP), 23 cases of bacterial pneumonia, 13 abscesses, 11 cases of sarcoidosis, and 34 other benign diseases. Among them, a definitive diagnosis was obtained by bronchoscopy with EBUS-GS in 99 lesions (58%). Lesions in which the probe was positioned within the lesion had a higher diagnostic yield (64%) than did lesions in which the probe was positioned adjacent to the lesion (52%) or outside the lesion (20%; P = 0.01). The diagnostic yield of bronchoscopy with EBUS-GS was higher compared with that of the historical control (58% versus 28%; P = 0.04).

Conclusions

Bronchoscopy using EBUS-GS is a reasonable option as a diagnostic procedure for PPLs, even if they are suspected to be benign in nature.

Section snippets

Ethics Committee Approval

This study was approved by the institutional review board of Hokkaido University Hospital (project approval number 008–0050), and all patients provided written informed consent.

Patients

We performed a retrospective chart review of patients referred to the Hokkaido University Hospital between April 2003 and June 2010 who underwent EBUS-GS. EBUS-GS was performed for 876 lesions during the study period (Fig 1). Six hundred sixty lesions were finally diagnosed as malignant lesions. Thirty-eight lesions were

Patient Characteristics and Benign Pulmonary Diseases Diagnosed With Bronchoscopy

The mean age of 159 patients (97 men, 62 women) was 61.8 years (range, 21 to 85 years). The diameter of the lesions was 26.6 ± 12.9 mm (mean ± SD; range, 6 to 69 mm); 57 lesions were located in the right upper lobe, 19 lesions were located in the right middle lobe, 42 lesions were located in the right lower lobe, 26 lesions were located in the left upper lobe, and 27 lesions were located in the left lower lobe. We performed 5.2 ± 1.9 biopsies (mean ± SD; range, 0 to 9) per pulmonary lesion. One

Comment

This report defines the diagnostic yield of benign pulmonary diseases, especially nodular lesions, when using bronchoscopy with EBUS-GS. By applying the classification of the contribution, we have focused on more details of the diagnostic steps in various types of benign pulmonary nodules. In combination with EBUS-GS, we have had a relatively higher diagnostic yield of 58% (grade A or B) for the diagnosis of benign pulmonary nodules. Our study has shown that bronchoscopy with EBUS-GS is

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