Additional transbronchial needle aspiration through a guide sheath for peripheral pulmonary lesions that cannot be detected by radial EBUS.
BACKGROUND
Endobronchial ultrasound with a guide sheath (EBUS-GS) has resulted to better diagnostic outcome for peripheral pulmonary lesions (PPLs), although the yield is not satisfactory for lesions that cannot be located by EBUS. We aimed to evaluate whether the addition of a new technique, transbronchial needle aspiration through a guide sheath (GS-TBNA), can increase the yield for these cases.


METHODS
This was a retrospective review of cases that were not located by EBUS during EBUS-GS for PPL diagnosis. From September 2012 to August 2014, 67 PPLs had 'invisible' EBUS-GS location prior to transbronchial sampling. The patients were divided into two groups according to the use of additional GS-TBNA: GS-TBNA group (n=22) and non-GS-TBNA group (n=45). Diagnostic yields were compared and multivariate analysis was performed to determine the factors associated with increased diagnostic yield.


RESULTS
The diagnostic yield was significantly higher in the GS-TBNA group than in the non-GS-TBNA group (54.5% vs 17.8%, P<0.01). The complication rate was not significantly different between the GS-TBNA group and the non-GS-TBNA group (0% vs 4.4%, P=1.0). Multivariate analysis showed that only performing GS-TBNA was significantly associated with increased diagnostic yield (odds ratio 3.99, P=0.03).


CONCLUSION
GS-TBNA is a safe technique for PPL diagnosis and may be useful when the EBUS probe cannot reach the lesion.
['Hayama|Manabu|M|', 'Izumo|Takehiro|T|', 'Chavez|Christine|C|', 'Matsumoto|Yuji|Y|', 'Tsuchida|Takaaki|T|', 'Sasada|Shinji|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001980:Bronchi D001999:Bronchoscopy D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration D019160:Endosonography D005260:Female D005471:Fluoroscopy D006801:Humans D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D012189:Retrospective Studies
transbronchial needle aspiration peripheral pulmonary lesion radial EBUS EBUS-GS GS-TBNA