Analysis of the Internal Structure of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography: EBUS
The average time that required to complete EBUS in 168 patients with peripheral pulmonary lesions was 8.38 min. Fluoroscopy was not able to confirm whether or not the forceps had reached the favorable point for endobronchial brushing and TBB. EBUS cannot create images of healthy air-filled lungs, but it can image peripheral pulmonary lesions because only small amounts of air come into contact with the probe. The exploration of some bronchi with the miniature probe allowed us to determine, more definitively than with fluoroscopy, which bronchus should be selected for endobronchial brushing and TBB. EBUS is also useful for examining lesions that are difficult to visualize by fluoroscopy (eg, lesions behind the mediastinum or diaphragm, ill-defined shadows, small lesions, and lesions behind another shadow). EBUS clearly identifies which bronchus is most closely related to the lesion and which bronchus should be subjected to biopsy. On fluoroscopy, the probe appeared at a slight distance even when the probe was at the site of the lesion, as demonstrated by the definitive diagnosis of adenocarcinoma by endobronchial brushing at the site of EBUS. This suggests that the area at the margins of the lesions contain more air, so the margins may appear normal on fluoroscopy, and the size of the lesion is underestimated. asthma inhalers
If EBUS is unable to reach a lesion, what procedure should be tried? The usefulness of a technique using a curette loaded into the guide sheath is now under investigation for visualizing lesions that are not accessible with a probe. In a modification of the technique, the curette, capped by a guide sheath, is introduced into the lesion. Then, the curette is withdrawn, leaving the guide sheath in situ. The miniature probe then is introduced through the guide sheath to the lesion and then pulled back for scanning to acquire EBUS images. The probe then is removed with the guide sheath left in situ in the lesion. A biopsy forceps or bronchial brush then is introduced into the sheath, and brushings and/or biopsy specimens are collected.
EBUS provides a new way to visualize the internal structures of peripheral pulmonary lesions. Classification of the ultrasonograms suggests the pathology and histology of the lesions.