Comparison of bronchoscopic diagnosis for peripheral pulmonary nodule under fluoroscopic guidance with CT guidance.

BACKGROUND A new diagnostic procedure has been established for the selection of appropriate therapy for small lung lesions. We compared the sensitivity of real-time multi-slice computed tomography (MSCT) and X-ray television (TV) fluoroscopic guidance for performing bronchoscopy. METHODS The first author performed and interpreted all bronchoscopies described in this study. The diagnosis of malignancy or benign was based on the results of histopathological examination, as well as clinical and imaging follow-up MSCT. We also compared the diagnostic yields of lesion size between MSCT and X-ray TV fluoroscopic guidance. RESULTS Real-time MSCT and X-ray TV fluoroscopic guidance was conducted in 82 and 78 patients, respectively. The lesion size detected by real-time MSCT and X-ray TV fluoroscopic guidance was <10 mm (n=21, 14), 11-15 mm (n=24, 12), 16-20 mm (n=19,14), 21-25 mm (n=9, 12) and >26 mm (n=9, 26). The sensitivity of real-time MSCT- and X-ray TV fluoroscopic guidance was 62.2% and 52.6%, respectively. The sensitivity of real-time MSCT fluoroscopic guidance for histopathologic diagnosis of lesions less than 15 mm was higher than that of X-ray TV fluoroscopic guidance. While it was difficult to histopathologically diagnose small lung lesions less than 10mm in diameter, real-time MSCT fluoroscopic guidance offers a better chance of such diagnosis, irrespective of the size of the lesion, compared with X-ray TV fluoroscopic guidance. CONCLUSION Real-time MSCT fluoroscopic guidance allows the bronchoscopist to accurately determine the location of the instruments in relation to the lesion in real time, thus helping to reduce the number of negative cases.

[1]  W. Baaklini,et al.  Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. , 2000, Chest.

[2]  N. Ishikawa,et al.  Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: the role of systematic nodal dissection. , 1998, Lung cancer.

[3]  P. Templeton,et al.  CT-assisted transbronchial needle aspiration: usefulness of CT fluoroscopy. , 1997, AJR. American journal of roentgenology.

[4]  S Sone,et al.  Growth rate of small lung cancers detected on mass CT screening. , 2000, The British journal of radiology.

[5]  C. Mountain,et al.  Revisions in the International System for Staging Lung Cancer. , 1997, Chest.

[6]  F Rong,et al.  CT scan directed transbronchial needle aspiration biopsy for mediastinal nodes. , 1998, Chest.

[7]  S. Goldberg,et al.  Mediastinal lymphadenopathy: diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance-initial experience. , 2000, Radiology.

[8]  A. Deutsch,et al.  Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule. , 1982, Chest.

[9]  Masaki Murayama,et al.  Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. , 2004, Chest.

[10]  Levin Dc,et al.  Flexible Fiberoptic Bronchoscopy and Fluoroscopically Guided Transbronchial Biopsy in the Management of Solitary Pulmonary Nodules , 1982 .

[11]  Satomi Takahashi,et al.  Clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions , 1990, Cancer.

[12]  Y. Onodera,et al.  Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions , 2004, European Respiratory Journal.

[13]  P C Goodman,et al.  Virtual bronchoscopy for directing transbronchial needle aspiration of hilar and mediastinal lymph nodes: a pilot study. , 1998, AJR. American journal of roentgenology.

[14]  C. Henschke,et al.  The solitary pulmonary nodule: update 1995. , 1995, The American journal of medicine.

[15]  V Chechani,et al.  Bronchoscopic diagnosis of solitary pulmonary nodules and lung masses in the absence of endobronchial abnormality. , 1996, Chest.