Tuberc Respir Dis > Volume 84(4); 2021 > Article
Lung Cancer
Tuberculosis and Respiratory Diseases 2021;84(4):282-290.
DOI:    Published online June 24, 2021.
Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy
Kyung Soo Hong, M.D.1  , Heeyun Ahn, M.D.1  , Kwan Ho Lee, M.D., Ph.D.1, Jin Hong Chung, M.D., Ph.D.1, Kyeong-Cheol Shin, M.D., Ph.D.1, Hyun Jung Jin, M.D., Ph.D.1, Jong Geol Jang, M.D.1, Seok Soo Lee, M.D., M.S.2, Min Hye Jang, M.D., Ph.D.3, June Hong Ahn, M.D., Ph.D.1 
1Division of Pulmonology and Allergy, Department of Internal Medicine, Respiratory Center, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
2Department of Thoracic and Cardiovascular Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
3Department of Pathology, Yeungnam University College of Medicine, Daegu, Republic of Korea
Correspondence:  June Hong Ahn, Tel: 82-53-640-6577, Fax: 82-53-620-3849, 
Received: 2 January 2021   • Revised: 24 March 2021   • Accepted: 23 June 2021
*Kyung Soo Hong and Heeyun Ahn contributed equally to this study as co-first authors.
Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. In this study, we investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs.
We retrospectively reviewed data from 607 patients who underwent RP-EBUS of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS without fluoroscopy. The diagnostic yield and complications were assessed. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields.
The overall diagnostic accuracy was 76.1% (462/607). In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.27–3.33; p=0.003), positive bronchus sign in chest computed tomography (OR, 2.30; 95% CI, 1.40–3.78; p=0.001), a solid lesion (OR, 2.40; 95% CI, 1.31–4.41; p=0.005), and an EBUS image with the probe within the lesion (OR, 6.98; 95% CI, 4.38–11.12; p<0.001) were associated with diagnostic success. Pneumothorax occurred in 2.0% (12/607) of cases and chest tube insertion was required in 0.5% (3/607) of patients.
RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method in diagnosing PPLs that does not involve radiation exposure and has acceptable complication rates.
Key Words: Bronchoscopy, Diagnosis, Peripheral, Ultrasonography

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