Ultrathin Bronchoscopy with Multimodal Devices for Peripheral Pulmonary Lesions. A Randomized Trial.
RATIONALE
The combination of an ultrathin bronchoscope, navigational technology, and endobronchial ultrasound (EBUS) seems to combine the best of mutual abilities for evaluating peripheral pulmonary lesions, but ultrathin bronchoscopes that allow the use of EBUS have not been developed so far.


OBJECTIVES
To compare the diagnostic yield of transbronchial biopsy under EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance using a novel ultrathin bronchoscope with that using a thin bronchoscope with a guide sheath for peripheral pulmonary lesions.


METHODS
In four centers, patients with suspected peripheral pulmonary lesions less than or equal to 30 mm in the longest diameter were included and randomized to undergo transbronchial biopsy with EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance using a 3.0-mm ultrathin bronchoscope (UTB group) or a 4.0-mm thin bronchoscope with a guide sheath (TB-GS group).


MEASUREMENTS AND MAIN RESULTS
A total of 310 patients were enrolled and randomized, among whom 305 patients (150, UTB group; 155, TB-GS group) were analyzed. The ultrathin bronchoscope could reach more distal bronchi than the thin bronchoscope (median fifth- vs. fourth-generation bronchi; P < 0.001). Diagnostic histologic specimens were obtained in 74% (42% for benign and 81% for malignant lesions) of the UTB group and 59% (36% for benign and 70% for malignant lesions) of the TB-GS group (P = 0.044, Mantel-Haenszel test). Complications including pneumothorax, bleeding, chest pain, and pneumonia occurred in 3% and 5% in the respective groups.


CONCLUSIONS
The diagnostic yield of the UTB method is higher than that of the TB-GS method. Clinical trial registered with www.umin.ac.jp/ctr/ (UMIN 000003177).
['Oki|Masahide|M|', 'Saka|Hideo|H|', 'Ando|Masahiko|M|', 'Asano|Fumihiro|F|', 'Kurimoto|Noriaki|N|', 'Morita|Katsuhiko|K|', 'Kitagawa|Chiyoe|C|', 'Kogure|Yoshihito|Y|', 'Miyazawa|Teruomi|T|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D020680:Bronchoscopes D001999:Bronchoscopy D019160:Endosonography D004867:Equipment Design D005260:Female D005471:Fluoroscopy D006801:Humans D061705:Image-Guided Biopsy D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D064847:Multimodal Imaging
bronchoscopy navigation EBUS lung cancer solitary pulmonary nodule