1. Department of Respiratory and Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
2. Pulmonary Department-Oncology Unit, “Theageneio“ Anticancer Hospital, Thessaloniki, Greece.
3. Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ''Hof'' Clinics, University of Erlangen, Hof, Germany.
4. International Union for Difficult-to-treat-Diseases (IUDD), MD, USA.
5. Department of anesthesiologist, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
* Huang Haidong, Ning Yunye, Zhang Wei contributed equally to this work.
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: bronchoscope, endobronchial ultrasound, radial probe, virtual bronchial navigation (VBN), EBUS-GS, fluoroscopy, peripheral pulmonary lesion, biopsy, diagnosis