Endobronchial Ultrasonography With a Guide Sheath in the Diagnosis of Benign Peripheral Diseases

摘要

Ethics Committee ApprovalPatientsTransbronchial Biopsy Using EBUS-GSDetermination of Grade for Bronchoscopy ContributionHistorical ControlStatistical AnalysisResultsPatient Characteristics and Benign Pulmonary Diseases Diagnosed With BronchoscopyEstimation of Bronchoscopy Contribution for Diagnosis of Pulmonary Benign DiseasesClinical Features of Peripheral Pulmonary Lesions Related to Diagnostic Yield and Comparison to the Contribution of Bronchoscopy Without EBUS-GSFor 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.MethodsWe 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).ResultsThe 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).ConclusionsBronchoscopy using EBUS-GS is a reasonable option as a diagnostic procedure for PPLs, even if they are suspected to be benign in nature.CTSNet classification:11Dr Shinagawa discloses that he has a financial relationship with Olympus Medical Systems.For pulmonary peripheral lesions (PPLs), computed tomography and positron emission tomography with fluorodeoxyglucose do not provide a definitive diagnosis. Benign pulmonary diseases include infections, sarcoidosis, and interstitial lung diseases, and it is pivotal to obtain a reliable diagnosis for such diseases. Without a confirmed diagnosis, patients tend to undergo empirical therapy that does not necessarily result in improvement. Surgical biopsy procedures such as video-assisted thoracoscopic surgery (VATS) have become a safe and common procedure, although they still carry a 6% to 7% risk of complications [