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Diagnostic Value of Endobronchial Ultrasonography with A Guide Sheath Combined with Virtual Bronchoscopic Biopsy for Pulmonary Peripheral Lesions

Background: Lung cancer is not only the most common tumor, but also the tumor of supreme incidence and death rate in all malignant tumors. Bronchoscopy has been widely used in the diagnosis of space occupying lung lesions, but the diagnostic rate of pulmonary peripheral lesions (PPL) is relatively low. The emergence of intra-airway ultrasound technology is a milestone for the development of respiratory endoscopy technology. The appearance of miniature lung ultrasound probe has greatly improved the accuracy of diagnosis of peripheral lung diseases, especially peripheral lung cancer. In recent years, guided sheath (GS) endobronchial ultrasonography with trans-bronchial lung biopsy (EBUS-TBLB) has been used to diagnose pulmonary peripheral lesions. The diagnostic rate is over 70%, and the incidence of adverse reactions is low. Objectives: The aim of the current study was to determine the diagnostic value of endobronchial ultrasonography with a guide sheath combined with virtual bronchoscopic biopsy (EBUS-GS-TBLB+VB) for PPL, and to find the factors that were correlated with greater diagnostic accuracy of EBUS-GS-TBLB. Patients and Methods: In this retrospective study, 87 patients with PPL were grouped according to different instrument-guided TBLB techniques, which included conventional TBLB, EBUS-GS-TBLB (E-TBLB), and EBUS-GS-TBLB+VB (E+V-TBLB). The diagnostic accuracy and duration of the operations were compared. Correlative factors were determined and any complications related to the operations were recorded. Results: The diagnostic accuracy of E+V-TBLB (16/20, 80%) and E-TBLB (22/29, 75.9%) were significantly better (P < 0.05) than that of TBLB (18/38, 47.4%), and the duration of the operation (minutes) was significantly shorter in E+V-TBLB (7.78 ± 2.0) than in E-TBLB (12.97 ± 3.4) (P = 0.018). We found that lesions with a diameter ≥ 2 cm (27/29, 93.1%) that were probe-penetrable (30/32, 93.5%), and with a computed tomography (CT) attenuation value > 20 HU were related to higher diagnostic accuracy in EBUS-GS-TBLB. All the patients tolerated the TBLB operations well. Bleeding occurred in one patient from the TBLB group. There was no pneumothorax, hemoptysis, or other complications in the other groups. Conclusion: The diagnostic accuracy of EBUS-GS-TBLB was much greater than that of TBLB, and patients showed better tolerance to it.