Peripheral airway bronchoscopy using a combination of thin/ultrathin bronchoscopes, radial endobronchial ultrasound and 2D fluoroscopy
A. Sadoughi*a (Prof), S. Virdia (Dr), D. Schectera (Dr), S. Synna (Dr), C. Christinea (Dr)
a Albert Einstein College of Medicine - Montefiore Medical Center, New York City, UNITED STATES
Diagnosis of peripheral lung lesions is still a challenge despite development of different technologies. Miniaturized bronchoscopes are reported to increase diagnostic yield (DY) by improving visualization of small caliber airways.
This is a cohort study of patients referred for peripheral lung lesion. We routinely use thin bronchoscope with the guide of radial endobronchial ultrasound (rEBUS) and 2D fluoroscopy. If the lesion is not localized with a concentric rEBUS view or the tip of the scope is far from the lesion, we use ultrathin bronchoscope [3.0 mm outer diameter at tip and 1.7 mm working channel]. Sampling tools include needle, forceps, brushing and bronchoalveolar lavage. Successful bronchoscopy is defined as either detection of a malignant, infection or inflammatory disease which can explain the clinical scenario. If none of the above are achieved, the lesions are followed either by surgical or transthoracic biopsy or at least 12 months radiological surveillance.
121 patients were referred for bronchoscopy from March 2019 to January 2021. 126 peripheral lung lesions were studied. The mean of the longest diameter of the lesions was 2.69 cm and the median was 2.2 cm (range 0.7 to 7.4 cm). Diagnosis was made in 106 lesions (DY 84%). 62 out of 72 patients with final diagnosis of malignancy were diagnosed via bronchoscopy (sensitivity 86%). Localizing the lesion was successful in 124 (98%) cases and concentric rEBUS view was found in 118 (95%) cases. There was only one patient with pneumothorax post procedure, and there was no major complication.
Combination of thin and ultrathin bronchoscopes with rEBUS and 2D fluoroscopy surveillance during peripheral airway bronchoscopy provides diagnostic yield comparative to CT-scan guided sampling. The high rate of success with low costs and complication rates makes this approach favorable for diagnosis of small and hard to reach lung lesions.
Disclosure of funding source(s): none