Multiple guided technologies based on radial probe endobronchial ultrasound for the diagnosis of solitary peripheral pulmonary lesions: a single-center study

Abstract

Objective To evaluate the value of multiple guided technologies based on radial probe endobronchial ultrasound (R-EBUS) in the application of the diagnosis of solitary pulmonary peripheral lesions (PPLs). Methods Analysis of diagnostic yield in 4 groups patients with different combined multiple guided technologies based on R-EBUS, 94 patients with 94 solitary PPLs from Mar, 2013 to Nov, 2014 in Changhai Hospital. Results The overall diagnostic yield was 75% (70/94), the diagnostic yield of Group A (R-EBUS) was 62%(16/26), Group B (R-EBUS with guided sheath, EBUS-GS) was 76% (34/45), Group C (EBUS-GS with fluoroscopy) was 82% (9/11), Group D (virtual bronchoscopic navigation guided EBUS-GS with fluoroscopy) was 92% (11/12). The overall histopathological diagnostic yield was 56% (53/94. Better histopathological diagnostic yield was associated with application of multiple guided technologies based on EBUS-GS, lesions located in non-lower lobes, lesion's diameter > 2cm, radial probe within the lesions and lidocaine nebulization combined with intravenous anesthesia. There were no severe complications in all the 94 cases. A ultrasonic radial probe was broken when exploring a lesion located in the apical-posterior segment of left upper lobe. Conclusion Multiple guided technologies based on R-EBUS were safe and effective in the diagnosis of solitary PPLs. In practice, the diagnosis yield improved with the application of forcep biopsies combined with bronchial brushing and washing.

Keywords: EBUS-GS; biopsy; bronchoscope; diagnosis; endobronchial ultrasound; fluoroscopy; peripheral pulmonary lesion; radial probe; virtual bronchial navigation (VBN).

Figure 1

a: The pulmonary CT scan showed a nodule with estimated diameter about 27×25mm in basal segment of the right lower lobe. Without guidance of VBN, ultrasonic radial probe was advanced into the lateral branch of the lesion (yellow arrow). b: The ultrasonic image showed that only one strip suspicious solitary density shadow was found on the edge of the probe with the longest diameter of 9mm. In the second procedure, EBUS-GS was advanced into the center position of lesion (red arrow) in the posterior basal segment of right lower lung under the guidance of VBN 3D electronic path. c: Ultrasonic image showed the typical solidary circular density shadow with clear boundary edge with the longest diameter about 12mm. The radial probe was located within the lesion.

Figure 2

Operator interface of VBN DirectPath 1.0. The left figure referred to the virtual bronchoscopy image generated by VBN system automatically. In the virtual image, the position of red dot was the target lesion in the distal posterior basal segment of right lower lobe. The red arrow showed the electronic path leading to the lesion. The upper left text revealed the distance from lesion to distal end of bronchus intermedius was 83mm in foot line and 72mm in straight line. The right figure referred to the CT cross section, coronal plane, and sagittal plane and the dynamic path under the three-dimensional reconstruction of the tracheobronchial tree.