Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions: A Randomized Trial.

Abstract:

BACKGROUND:When evaluating peripheral pulmonary lesions, a 3.0-mm ultrathin bronchoscope (UTB) with a 1.7-mm working channel is advantageous regarding good access to the peripheral airway, whereas a 4.0-mm thin bronchoscope provides a larger 2.0-mm working channel, which allows the use of various instruments including a guide sheath (GS), larger forceps, and an aspiration needle. This study compared multimodal bronchoscopy using a UTB and a thin bronchoscope with multiple sampling methods for the diagnosis of peripheral pulmonary lesions. METHODS:Patients with peripheral pulmonary lesions ≤ 30 mm in diameter were recruited and randomized to undergo endobronchial ultrasonography, virtual bronchoscopy, and fluoroscopy-guided bronchoscopy using a 3.0-mm UTB (UTB group) or a 4.0-mm thin bronchoscope (thin bronchoscope group). In the thin bronchoscope group, the use of small forceps with a GS or standard forceps without the GS was permitted. In addition, needle aspiration was performed for lesions into which an ultrasound probe could not be inserted. RESULTS:A total of 360 patients were enrolled, and 356 were included in the analyses (median largest lesional diameter, 19 mm). The overall diagnostic yield was significantly higher in the UTB group than in the thin bronchoscope group (70.1% vs 58.7%, respectively; P = .027). The procedure duration was significantly shorter in the UTB group (median, 24.8 vs 26.8 min, respectively; P = .008). The complication rates were 2.8% and 4.5%, respectively (P = .574). CONCLUSIONS:Multimodal bronchoscopy using a UTB afforded a higher diagnostic yield than that using a thin bronchoscope in the diagnosis of small peripheral pulmonary lesions. TRIAL REGISTRY:UMIN Clinical Trials Registry; No.: UMIN000010133; URL: https://www.umin.ac.jp/ctr/.

journal_name

Chest

journal_title

Chest

authors

Oki M,Saka H,Asano F,Kitagawa C,Kogure Y,Tsuzuku A,Ando M

doi

10.1016/j.chest.2019.06.038

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

954-964

issue

5

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(19)31382-0

journal_volume

156

pub_type

杂志文章,多中心研究,随机对照试验

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