Randomized study of endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) using 3.4-mm thin bronchoscope vs. EBUS with guide sheath (GS)-guided TBB using 4.0-mm bronchoscope for diagnosis of peripheral pulmonary lesions - Randomized study of EBUS-guided TBB using thin bronchoscope vs. EBUS-GS-guided TBB for diagnosis of peripheral pulmonary lesions

Background: In endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB), techniques using a thin bronchoscope or a guide sheath have been proposed for accurate biopsy instrument re-insertion into the bronchial route indicated by a radial ultrasonic probe. The purpose of the present study was to compare the diagnostic yields of these techniques for peripheral pulmonary lesions. Methods: Patients with suspected peripheral pulmonary lesions were included in this prospective, randomized, non-inferiority study and assigned to undergo EBUS-TBB under fluoroscopic guidance using a prototype 3.4-mm thin bronchoscope or a 4.0-mm bronchoscope with a guide sheath. Results: A total of 205 patients were enrolled and randomized, of whom 203 patients (101, thin bronchoscopic method; 102, guide sheath method) were included in the analysis. Diagnostic histologic specimens were obtained in 65% (41% for benign and 75% for malignant lesions) of the thin bronchoscopy group and 62% (25% for benign and 71% for malignant lesions) of the guide sheath group. Diagnostic performance of the thin bronchoscopic method was confirmed to be non-inferior to the guide sheath method (difference in diagnostic yields, 3.6%; 90% confidence interval, -7.5 to 14.7%). Mean procedure time was significantly shorter in the thin bronchoscopy group than the guide sheath group (27 min vs. 33 min; p = 0.002). Complications including pneumothorax, moderate bleeding and pneumonia occurred in 5% and 2% in the respective groups. Conclusions: The diagnostic yields of each method are similar. EBUS-TBB using the thin bronchoscope can be performed more simply and less expensively without a guide sheath, and seems more practical.