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Kim, Park, Kim, Oak, Jang, Jung, and Chun: The Usefulness of Endobronchial Ultrasonogram for Peripheral Lung Lesion
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(6): 545-550.

Published online: 31 December 2009

DOI: https://doi.org/10.4046/trd.2009.67.6.545

The Usefulness of Endobronchial Ultrasonogram for Peripheral Lung Lesion

Sung Bin Kim, M.D.1, Jin Hee Park, M.D.1, Ye Na Kim, M.D.1, Chul Ho Oak, M.D.1, Tae Won Jang, M.D.1, Man Hong Jung, M.D.1, Bong Kwon Chun, M.D.2

1Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

2Department of Pathology, Kosin University College of Medicine, Busan, Korea.

Address for correspondence: Chul Ho Oak, M.D. Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan 602-702, Korea. Phone: 82-51-990-6104, Fax: 82-51-990-3049, oaks70@hanmail.net

Received 3 September 2009       Accepted 27 November 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Endobronchial ultrasonogram (EBUS) has increased the diagnostic yield of a bronchoscopic biopsy of peripheral pulmonary lesions (PPL). This study evaluated the diagnostic yield of EBUS-guided transbronchial biopsy (TBB) and the visibility of EBUS PPL.

Methods

Between August 2007 and November 2008, 50 patients (32 men and 18 women, median age, 61.1±10 yrs; range, 16 to 80 yrs) whose PPL lesions could not be detected with flexible bronchoscopy were enrolled in this study. Among the 50 patients, 40 cases were malignant lesions (adenocarcinoma 25, squamous cell carcinoma 10, small cell carcinoma 5) and 10 cases were benign lesions (tuberculoma 7, fungal ball 1, other inflammation 2).

Results

The mean diameter of the target lesion was 35.4±4.3 mm. Of the 50 patients examined, the overall diagnostic yield by EBUS-TBLB was 46.0% (23/50). The visualization yield of EBUS was 66.0% (33/50). A definitive diagnosis of PPL localized by EBUS was established using EBUS-TBLB in 69.6% (23/33) of cases. The diagnostic yields from washing cytology and brushing cytology from a bronchus identified by EBUS were 27.0% and 45.4% respectively. The diagnostic yields reached 78.7% when the three tests (washing cytology, brushing cytology and EBUS-TBLB) were combined. The visualization yield of EBUS in lesions <20 mm was significantly lower than that in lesions ≥20 mm (p=0.04). The presence of a bronchus leading to a lesion (open bronchus sign) on the chest CT scan was associated with a high visualization yield on EBUS (p=0.001). There were no significant complications associated with EBUS-TBLB.

Conclusion

EBUS-TBLB is a safe and effective method for diagnosing PPL. The lesion size and open bronchus signs are significant factors for predicting the visualization of EBUS.

Keywords: Bronchoscopy, Endosonography, Solitary Pulmonary Nodule, Lung Neoplasms

Figures and Tables

Figure 1
20 MHz mechanical radial type probe with an external diameter of 1.7 mm (UM-4R; Olympus).
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Figure 2
(A) CT scan showed spiculated round opacity with open bronchus sign. (B) EBUS showed homogenous echogenesity surrounded by echogenic band with concentric position of probe.
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Table 1
Patient demographics
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*TBLB+Washing+Brushing.

Table 2
Location of lesions
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Table 3
Diagnostic yields by washing cytology, brushing cytology and EBUS-TBLB in 33 patients*
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EBUS-TBLB: endobronchial ultrasonogram guided transbronchial lung biopsy.

*Whose lesions were visualized by EBUS.

Table 4
Characteristics of lesions underwent by EBUS-TBLB
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EBUS-TBLB: endobronchial ultrasonogram guided transbronchial lung biopsy.

Notes

This research was received support from scientific expenses of Kosin Medical College.

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