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Endobronchial Ultrasound (EBUS) guided transbronchial lung biopsy (TBB) in fluoroscopic invisible solitary pulmonary nodules (SPN) –a prospective trial

Thoraxklinik, Heidelberg, Germany

PURPOSE: Transbronchial biopsy for SPN is usually performed under fluoroscopic guidance. Depending on the size, nodules smaller than 3 cm are often fluoroscopically invisible and the yield of TBB may drop dramatically. EBUS allows visualisation of small nodules. The study aimed to asses the yield of EBUS guided TBB in fluoroscopic invisible solitary pulmonary nodules.

METHODS: All patients with SPN and indication for a bronchoscopy were included in the study. In case of fluoroscopic invisibility the EBUS guided examination was performed. The EBUS probe was introduced via a guide catheter into the presumed segment. If a typical ultrasonic picture could be seen, the probe was removed and the catheter left in place. A biopsy forceps was then introduced and specimens were taken.

RESULTS: 138 patients with SPNs were examined. Of those, 54 patients (18 female, 36 male, mean age 46,3 range 35-78) presented with a SPN that could not be visualized with fluoroscopy. In 48 (88.9 %) the leasion could be reached with EBUS, in 38 (70 %) cases the biposy established the diagnosis. All undiagnosed SPNs were referred for surgical biopsy. In the 16 patients who underwent surgery, the pathology was malignant in 10 and benign in 6. The mean diameter of the nodules was 2,2 (R1,4-3,3) cm. The mean examination time (including the biopsies) amounted to 12.3 minutes (R 6-18), the mean number of biopsies was 4,5 (3-6). One patient developed a pneumothorax, other complications were not seen.

CONCLUSION: EBUS guided TBB is a safe and effective method to biopsy SPNs that are not visualized by fluoroscopy.

CLINICAL IMPLICATIONS: EBUS guided transbronchial lung biopsy may increase the yield of endoscopic biopsy in patients with solitary pulmonary nodules and avoid surgical procedures.

DISCLOSURE: F.J. Herth, None.