Endobronchial Ultrasonography with a Guide Sheath for Pure or Mixed Ground-Glass Opacity Lesions

Abstract

Background: Ground-glass opacity (GGO) lesions are difficult to diagnose by transbronchial biopsy (TBB). Objectives: We attempted to diagnose solitary peripheral GGO predominant-type lesions by TBB using endobronchial ultrasonography with a guide sheath (EBUS-GS) under X-ray fluoroscopic guidance, and to evaluate several factors associated with diagnostic yield. Methods: The medical records of 67 patients with GGO predominant-type lesions who underwent TBB using EBUS-GS under X-ray fluoroscopic guidance were retrospectively reviewed. Results: Of the 67 lesions, 38 (57%) were successfully diagnosed by EBUS-GS (5/11 pure GGO lesions and 33/56 mixed GGO lesions). The diagnosable lesions were significantly larger than the nondiagnosable lesions (24 vs. 17 mm, respectively; p < 0.01). Regarding the diagnostic yield by signs on computed tomography, the lesions with a bronchus leading directly to a lesion had a significantly higher diagnostic yield than the others (p < 0.05). When GGO lesions were confirmed under X-ray fluoroscopic guidance, the diagnostic yield was 79% (vs. 40% in lesions not visible on X-ray fluoroscopy; p < 0.05). Conclusions: EBUS-GS is a useful and valuable diagnostic modality, even for GGO predominant-type lesions located at the lung periphery.

Usefulness of Endobronchial Ultrasonography With a Guide Sheath and Virtual Bronchoscopic Navigation for Ground-Glass Opacity Lesions

“…Although peripheral GGO predominant-type lesions are difficult to diagnose by bronchoscopy, there have been several reports demonstrating a promising diagnostic yield by TBB using EBUS-GS [14,27]. This is the first study to demonstrate a promising diagnostic yield for peripheral GGO predominant-type lesions by TBB using EBUS-GS and VBN; of the 169 lesions included in the present study, 116 (69%) were successfully diagnosed by this method.…”

“…We previously reported that EBUS-GS without VBN could be useful in clinical practice for diagnosing GGO predominant-type lesions in the peripheral lung, and described the advantages of EBUS-GS [14]. Especially, in the case of pure GGO, the change in brightness on EBUS images was very delicate when the EBUS probe was in and out of the lesions (Figure 1c).…”

“…Especially, in the case of pure GGO, the change in brightness on EBUS images was very delicate when the EBUS probe was in and out of the lesions (Figure 1c). However, after becoming familiar with the changes of the EBUS images, the positions of pure GGO can be confirmed and EBUS-GS become useful modality to 14 diagnose pure GGO predominant-type lesions. These advantages are also applicable to TBB using EBUS-GS and VBN.…”

“…However, several methodologic problems hinder diagnosis of GGO predominant-type lesions by transbronchial biopsy (TBB): (1) the lesions may not be visible under X-ray fluoroscopic 6 guidance; (2) there is difficulty in identifying accessible bronchial routes to reach peripheral lesions within the time limitation of the procedure; and (3) it is difficult to confirm whether biopsy forceps or a brush can accurately reach the lesions. We previously reported that EBUS-GS could be useful in clinical practice for diagnosing GGO predominant-type lesions in the peripheral lung [14,15], and recent studies have reported that some of these lesions are likely to be diagnosed as adenocarcinoma or precancerous lesions [14,[16][17][18][19].…”

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

“…The following studies reported that the diagnostic yield of EBUS-GS for PPLs was between 57% and 90%, and it was proved to be a safe procedure with low rate of pneumothorax and hemoptysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Till now there is only one randomized controlled study (22) comparing the two procedures.…”