The diagnostic utility of endobronchial ultrasonography with a guide sheath and tomosynthesis images for ground glass opacity pulmonary lesions

Abstract

Background: With the widespread use of computed tomography (CT), the frequency of discovering ground glass opacity (GGO) pulmonary lesions has increased. There have been some reports on surgery or transthoracic needle aspiration (TTNA) for diagnostic sampling of GGOs but none on transbronchial biopsy (TBB). The purpose of this study was to evaluate the diagnostic utility of chest tomosynthesis images and TBB through endobronchial ultrasonography with a guide sheath (EBUS-GS) for GGO.

Methods: This study included 40 patients (19 men, 21 women; age 66.9±8.7 years, mean ± standard deviation, SD). The mean lesion diameter was 22±10 mm (mean ± SD). Chest tomosynthesis images served as maps prior to bronchoscopic sampling using radial EBUS probe with a guide sheath kit.

Results: The overall diagnostic yield of EBUS-GS-guided TBB was 65.0% (26 of 40 lesions). In a multivariate analysis, diagnostic yield of lesions with EBUS images (79.2%, 19 of 24 cases) was significantly higher than those lesions without EBUS images detected (43.8%, 7 of 16 cases) (P=0.017). Detectability on chest tomosynthesis was not a significant contributing factor. Only one complication was observed: pneumothorax that did not require chest tube drainage.

Conclusions: TBB through EBUS-GS can be considered as one of the diagnostic methods for GGO. Further technological development is required to identify the location of the target GGO lesion more precisely.

Keywords: Bronchoscopy and interventional techniques; chest tomosynthesis; endobronchial ultrasonography with a guide sheath (EBUS-GS); ground glass opacity (GGO); lung cancer.

Figures

Figure 1

A representative case of guided bronchoscopy in a 59-year-old man with mixed ground glass opacity (GGO) in right upper lobe. (A) No abnormal shadow on chest radiograph; (B) Chest tomosynthesis showing a GGO lesion in the right upper lung field clearly (arrow); (C) High resolution CT scan shows a 24 mm mixed GGO in right S1a; (D) Real-time fluoroscopy imaging during EBUS-GS procedure; (E) The EBUS image revealed a pattern of low-echoic lesion with hyperechoic dots and linear arcs without vessels. (F) Histopathological specimen from the transbronchial biopsy showed cuboidal tumor cells lining the entrapped alveolar space. (hematoxylin-eosin stain, ×200). Abbreviation: EBUS-GS, endobronchial ultrasonography with a guide sheath.