Tuberc Respir Dis.  2009 Dec;67(6):545-550.

The Usefulness of Endobronchial Ultrasonogram for Peripheral Lung Lesion

• Kim SB
• Park JH
• Kim YN
• Oak CH
• Jang TW
• Jung MH
• Chun BK

Abstract

BACKGROUND
Endobronchial ultrasonogram (EBUS) has increased the diagnostic yield of a bronchoscopic biopsy of peripheral pulmonary lesions (PPL). This study evaluated the diagnostic yield of EBUS-guided transbronchial biopsy (TBB) and the visibility of EBUS PPL. METHODS: Between August 2007 and November 2008, 50 patients (32 men and 18 women, median age, 61.1+/-10 yrs; range, 16 to 80 yrs) whose PPL lesions could not be detected with flexible bronchoscopy were enrolled in this study. Among the 50 patients, 40 cases were malignant lesions (adenocarcinoma 25, squamous cell carcinoma 10, small cell carcinoma 5) and 10 cases were benign lesions (tuberculoma 7, fungal ball 1, other inflammation 2). RESULTS: The mean diameter of the target lesion was 35.4+/-4.3 mm. Of the 50 patients examined, the overall diagnostic yield by EBUS-TBLB was 46.0% (23/50). The visualization yield of EBUS was 66.0% (33/50). A definitive diagnosis of PPL localized by EBUS was established using EBUS-TBLB in 69.6% (23/33) of cases. The diagnostic yields from washing cytology and brushing cytology from a bronchus identified by EBUS were 27.0% and 45.4% respectively. The diagnostic yields reached 78.7% when the three tests (washing cytology, brushing cytology and EBUS-TBLB) were combined. The visualization yield of EBUS in lesions <20 mm was significantly lower than that in lesions > or =20 mm (p=0.04). The presence of a bronchus leading to a lesion (open bronchus sign) on the chest CT scan was associated with a high visualization yield on EBUS (p=0.001). There were no significant complications associated with EBUS-TBLB. CONCLUSION: EBUS-TBLB is a safe and effective method for diagnosing PPL. The lesion size and open bronchus signs are significant factors for predicting the visualization of EBUS.

Keyword

Bronchoscopy; Endosonography; Solitary Pulmonary Nodule; Lung Neoplasms

MeSH Terms

Biopsy
Bronchi
Bronchoscopy
Carcinoma, Small Cell
Carcinoma, Squamous Cell
Endosonography
Female
Humans
Inflammation
Lung
Lung Neoplasms
Male
Solitary Pulmonary Nodule
Thorax

Figure

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  Figure 1 20 MHz mechanical radial type probe with an external diameter of 1.7 mm (UM-4R; Olympus).

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  Figure 2 (A) CT scan showed spiculated round opacity with open bronchus sign. (B) EBUS showed homogenous echogenesity surrounded by echogenic band with concentric position of probe.

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