Transbronchial Biopsy for Peripheral Pulmonary Lesions Under Real-time Endobronchial Ultrasonographic Guidance

Background and Objectives: Transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) is a promising technique for small peripheral pulmonary lesions (PPLs), but is not a real-time procedure. We attempted to examine the practicality of TBB under real-time EBUS guidance for PPLs. Methods: We performed TBB under real-time EBUS and x-ray fluoroscopic guidance using flexible bronchoscopy with 2 working channels for PPLs (mean diameter, > 30 mm). Results: Between January 2007 and May 2007, we recruited 6 patients for this trial. On computed tomography images, the mean +/- SD diameter of the lesions was 37.4 +/- 4.5mm (range: 32.0 to 45.0 mm). All lesions were detected by EBUS and could eventually be diagnosed. However, an image of the biopsy forceps or brush was obtained on real-time EBUS in only 4 cases. The other 2 cases involved technical limitations in inserting both the EBUS probe and biopsy forceps simultaneously into the lesion. Unfortunately, even in the 4 cases in which biopsy forceps images could be obtained on real-time EBUS, we could not recognize the position of the tip of the forceps on EBUS images, because the EBUS images of the tip of the forceps and the body of forceps were very similar. Conclusions: Our attempt to perform TBB under real-time EBUS guidance for PPLs was successful in 4 of 6 patients. There were some technical limitations using flexible bronchoscopy with 2 working channels. Improvement of instruments will be necessary for future trials of TBB under real-time EBUS guidance.