Ultrathin bronchoscopy boasts higher diagnostic yield for peripheral pulmonary lesions

The diagnostic yield for peripheral pulmonary lesions is higher with ultrathin bronchoscopy compared to thin bronchoscopy, as shown in a study, noting that a radial probe endobronchial ultrasound (rEBUS) cannot be inserted through a thin bronchoscope.

A multicentre prospective study was conducted to evaluate the efficacy of sequential ultrathin bronchoscopy for peripheral pulmonary lesions into which the rEBUS probe could not be inserted during thin bronchoscopy.

The authors included patients with peripheral pulmonary lesions ≤30 mm in diameter who underwent rEBUS-guided transbronchial biopsy using a 4.0-mm diameter bronchoscopy. In those with lesions into which a rEBUS probe would not fit, bronchoscopy using a 3.0-mm diameter ultrathin bronchoscope was carried out.

Of the 342 patients enrolled in the study, 340 were included in the analysis. Eighty-seven of 340 patients with lesions of a median longest diameter of 17.5 mm underwent thin bronchoscopy, followed by ultrathin bronchoscopy.

Of the 87 patients, 50 (57.5 percent) had a successful insertion of the rEBUS probe into the lesions via the ultrathin bronchoscopy. In addition, the diagnostic yields were 12.6 percent (11 of 87) with thin bronchoscopy and 41.4 percent (36 of 87) with ultrathin bronchoscopy (p<0.001).

“The diagnostic yield of thin bronchoscopy with rEBUS of peripheral pulmonary lesions into which the rEBUS probe cannot be inserted is unsatisfactory,” the authors said. “In such cases, adding ultrathin bronchoscopy may be an option.”