Chest
Volume 129, Issue 1, January 2006, Pages 147-150
Journal home page for Chest

Original Research: Interventional Bronchoscopy
Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Fluoroscopically Invisible Solitary Pulmonary Nodules: A Prospective Trial

https://doi.org/10.1378/chest.129.1.147Get rights and content

Study objectives

Transbronchial biopsy (TBBX) for solitary pulmonary nodules (SPNs) is usually performed under fluoroscopic guidance, but the diagnostic yield depends on lesion size and varies widely. Nodules < 3 cm frequently cannot be visualized fluoroscopically. An alternative guidance technique, endobronchial ultrasound (EBUS), also allows visualization of pulmonary nodules. This study assessed the diagnostic yield of EBUS-guided TBBX in fluoroscopically invisible SPNs.

Design

The study was a prospective trial using a crossover design.

Patients and methods

All patients with SPNs and indications for bronchoscopy were included in the study. An EBUS-guided examination was performed in patients with fluoroscopically invisible nodules. The EBUS probe was introduced through a guide catheter into the presumed segment. If a typical ultrasonic picture of solid tissue could be seen, the probe was removed and the catheter left in place. The biopsy forceps were introduced and specimens taken.

Results

One hundred thirty-eight consecutive patients with SPNs were examined. Of those, 54 patients presented with SPNs that could not be visualized with fluoroscopy. The mean diameter of the nodules was 2.2 cm. In 48 patients (89%), the lesion was localized with EBUS, and in 38 patients (70%) the biopsy established the diagnosis. The 16 patients with undiagnosed SPNs were referred for surgical biopsy; 10 of those lesions were malignant and 6 were benign. The diagnosis in nine patients (17%) saved the patients from having to undergo a surgical procedure. The only complication was a pneumothorax in one patient.

Conclusions

EBUS-guided TBBX is a safe and very effective method for SPNs that cannot be visualized by fluoroscopy. The procedure may increase the yield of endoscopic biopsy in patients with these nodules and avert the need for surgical procedures.

Section snippets

Patients and Methods

In a prospective crossover study from January 2003 to January 2004, all patients with SPNs who were referred for diagnostic bronchoscopy were enrolled. All chest CTs were reviewed, and the size of the lesions was recorded by their longest diameter. The procedures used in the study were in accordance with the recommendations found in the Helsinki Declaration of 1975. The study was approved by the institutional review board, and written informed consent was obtained in all patients, after which

Results

One hundred thirty-eight consecutive patients with SPNs were examined. Of those, 54 patients (18 women and 36 men; mean age, 46.3 years; range, 35 to 78 years) presented with fluoroscopically invisible SPNs and were included in the trial population. The mean ± SD diameter of the lesion was 2.2 ± 0.7 cm (range, 1.4 to 3.3 cm). The nodules were located in the right middle lobe in 8 patients (15%), the left upper lobe in 10 patients (18%), the right upper lobe in 14 patients (26%), the left lower

Discussion

The need to workup and manage pulmonary nodules and masses is encountered with increasing frequency in chest medicine. A commonly performed procedure, endoscopic transbronchial biopsy, is associated with many problems. The yield greatly depends on the size and location of the abnormality2367 and generally on the ability to visualize the lesion fluoroscopically. The frequently small abnormalities that cannot be visualized with fluoroscopy present a particular problem because transbronchial

Cited by (205)

View all citing articles on Scopus

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

The endobronchial ultrasound probe was loaned to the authors by Olympus Ltd., Tokyo, Japan, for the duration of this study.

View full text