Endobronchial ultrasound plus fluoroscopy versus fluoroscopy-guided bronchoscopy: A comparison of diagnostic yields in peripheral pulmonary lesions

Background: Even though fluoroscopy-guided bronchos-copy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. However, there are few studies that directly compare the success rate of fiber-optic bronchoscopy with fluoroscopic guidance to that of EBUS guidance in the diagnosis of PPLs in the same institute and in the same study period. The aim of this study was to compare the performance of EBUS plus fluoroscopy guidance with that of fluoroscopy-guided bronchoscopy in the diagnosis of PPLs. Methods: A retrospective study was conducted on 114 patients who were diagnosed with PPLs and underwent either EBUS plus fluoroscopy or fluoroscopy-guided bronchoscopy. The diagnostic yields of both modalities were calculated. Results: The mean diameter of the PPLs measured by computed tomography of the chest was 23.7 mm. EBUS plus fluoroscopy obtained higher diagnostic yield than fluoros-copy-guided bronchoscopy (82.5 vs. 57.9%; P = 0.004). Subgroup analysis demonstrated that for PPLs larger than 20 mm, the accuracy of EBUS plus fluoroscopy was not different from that of the fluoroscopy-guided technique (85.7 vs. 72.2%, respectively; P = 0.19). In contrast, for lesions smaller than 20 mm, EBUS plus fluoroscopy guidance provided significantly greater diagnostic performance than fluo-roscopy-guided bronchoscopy (79.3 vs. 33.3%; P = 0.001). Conclusion:s Bronchoscopy under EBUS and fluoroscopy guidance improved the diagnostic yield of PPLs, especially of those smaller than 20 mm in diameter.