Radial Endobronchial Ultrasonography with a Guide Sheath for the Diagnosis of Diffuse Parenchymal Lung Diseases
Abstract Background Radial-endobronchial ultrasonography (R-EBUS) is a useful bronchoscopic tool for the diagnosis of solitary pulmonary peripheral lesions. However, the utility of R-EBUS for the diagnosis of diffuse parenchymal lung disease (DPLD) remains unclear. This study aimed to examine the characteristics of R-EBUS patterns in association with computed tomography (CT) findings in diagnosing DPLD. Methods Transbronchial lung biopsy (TBLB) was performed using R-EBUS and a guide sheath (GS) in consecutive 35 patients with suspected DPLD on chest CT between March–November 2017. Consolidation, ground glass opacity (GGO), reticular, and nodular patterns were diagnosed, and the mean CT Hounsfield units in the sampled area were measured in patients with consolidation. R-EBUS characteristics and their association with CT findings and pathological diagnostic yield were evaluated. Results R-EBUS showed a dense pattern only in patients with consolidation, and a blizzard pattern in patients with consolidation, GGO, reticular, and nodular patterns on CT. The biopsied area’s mean CT value was significantly higher in patients with dense than with blizzard patterns (p < 0.0001), and pathological findings were also dense in patients with R-EBUS dense pattern. The pathological diagnostic yield was significantly higher in patients with overt R-EBUS patterns than in patients without R-EBUS patterns by obtaining better lung tissue samples with the GS (p < 0.0001). Conclusions Dense and blizzard R-EBUS patterns were novel findings in diagnosing DPLD, and TBLB with R-EBUS-GS may be a valuable tool in diagnosing DPLD