• Motoko Yoshikawa, Noriaki Sukoh, Koichi Yamazaki, Kenya Kanazawa, Shin-ichi Fukumoto, Masao Harada, Eiki Kikuchi, Mitsuru Munakata, Masaharu Nishimura, and Hiroshi Isobe.
• Department of Pulmonary Diseases, National Hospital Organization Hokkaido Cancer Center, Kikusui-4-2, Shiroishiku, Sapporo 060-8638, Japan.
• Chest. 2007 Jun 1;131(6):1788-93.

Study ObjectivesWe evaluated the feasibility and efficacy of transbronchial biopsy (TBB) and bronchial brushing by endobronchial ultrasonography (EBUS) with a guide sheath (GS) as a guide for diagnosing peripheral pulmonary lesions (PPLs) without radiographic fluoroscopy.PatientsOne hundred twenty-one patients with 123 PPLs (mean diameter, 31.0 mm) whose bronchoscopic findings were normal.MethodsAn EBUS-GS was inserted and advanced to the PPL without fluoroscopy. Once we obtained the EBUS image, the probe was withdrawn and the GS was left in place. TBB and/or bronchial brushing were performed via the GS. When an EBUS image could not be obtained, we changed to the bronchoscopic examination under fluoroscopy.ResultsSeventy-six of 123 PPLs (61.8%) were diagnosed by EBUS-GS guidance without fluoroscopy. The diagnostic yield for PPLs > 20 mm in diameter (75.6%) was significantly higher than that for those ConclusionsEBUS-GS-guided bronchoscopy without the use of radiographic fluoroscopy is effective for diagnosing PPLs. The diameter, location, and CT scan appearance of the PPLs, and the identification of the bronchus leading to the PPLs were valuable as factors related to a higher diagnostic sensitivity with this procedure.

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