CT Bronchus Sign and Diagnostic Value of Fluoroscopy-guided Transbronchial Biopsy in Lesions without Endobronchial Pathology

Abstract

Aim: Fiberoptic bronchoscopy (FOB) is widely used for the diagnosis of solitary pulmonary nodules, masses and infiltrative lesions. In the diagnosis of peripheric pulmonary lesions, which doesn't have an endobronchial patology, bronchial washing, brushing, transbronchial biopsy (TBB), transbronchial needle aspiration biopsy and transthoracic needle aspiration biopsies are used under the guidance of several imaging modalities. In this study, we assesed the diagnostic value of fluoroscopy-guided TBB in pulmonary lesions without endobronchial component.

Material and methods: Between 2006 and 2009, 32 patients who had nodules, masses or infiltrations = 2 cm on plain radiogram and no visible endobronchial lesion on FOB session was enrolled. Study design was retrospective. Lesions on computerized tomography was assessed by a single radiologist. We obtained four different TBB with video bronchoscope under the guidance of two dimentional fluoroscopy in each patient. We evaluated the diagnostic accuracy of fluoroscopy guided TBB, depending on size, anatomic and radiologic localization and airway-lesion relationship according to Tsuboi classification.

Results: In twelve of 13 patients (92,3%) in group Tsuboi 1 and 2, diagnosis was achieved by fluoroscopy guided TBB. This method was diagnostic in ten of 19 patients (52.6%) in group Tsuboi 3 and 4. The difference in diagnostic accuracy between two groups was statistically significant (p = 0.024).

Conclusion: Fluoroscopy-guided TBB is found to be a cheap, safe and successful method in patients without endobronchial pathology, especially who are classified in Tsuboi group 1 and 2.