Ultrathin Bronchoscopy as an Adjunct to Standard Bronchoscopy in the Diagnosis of Peripheral Lung Lesions

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Abstract
Background: The role of the standard bronchoscope as a method of diagnosis of peripheral lung lesions is limited. Objectives: To evaluate the role of the ultrathin bronchoscope as an adjunct to standard bronchoscopy in the diagnosis of peripheral lung lesions. Methods: Seventeen consecutive patients with a peripheral lung lesion on chest radiography or chest CT. All patients underwent a bronchoscopic examination with a standard size bronchoscope, and if there was no evidence of endobronchial lesion, these patients were subsequently examined with an Olympus 3C40 ultrathin bronchoscope (external diameter of 3.6 mm). Under fluoroscopic guidance, cytological brushing samples were taken with the ultrathin bronchoscope followed by a reexamination with the standard bronchoscope which followed the same ‘pathway’ to the lesion established by the 3C40 ultrathin bronchoscope. Transbronchial biopsies (TBB) and cytological samples were taken with the standard bronchoscope. Results: The size of the lesions ranged from 1.5 to 7.0 cm. A positive bronchoscopic diagnosis by TBB was obtained in 11 out of 17 patients (64.7%) and a diagnosis of atypical cells suspicious for malignancy noted in a further 3 patients. For lesions less than 3 cm in size, a positive diagnosis by TBB was achieved in 7 out of 10 of these cases. The lesion was directly visualized with the ultrathin bronchoscope in 4 cases. Conclusions: Ultrathin bronchoscopy appears to be a useful adjunct to standard bronchoscopy by providing an accurate pathway to the lesion in question. However, further studies with larger patient groups are warranted.