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Combination of Bronchoscopic Techniques is Very Effective for Lung Lesions

A new study shows that the combined use of two minimally invasive techniquesendobronchial ultrasound (EBUS) and electromagnetic navigation bronchoscopy (ENB)-- in the diagnosis of peripheral lung lesions has been shown to be more effective than either procedure alone and does not compromise patients safety.

Multimodality diagnosis with the joint use of EBUS with ENB has pushed the diagnostic yield of flexible bronchoscopic procedures closer to the sensitivity obtainable through either transthoracic CT-guided or surgical biopsies, noted Armin Ernst, M.D., of Harvard Medical School, who wrote the article with colleagues at the University of Heidelberg, Germany.

The ultimate goal of reliable and minimally invasive biopsy of peripheral lung lesions new appears feasible.

The results of the prospective, randomized and multicenter trial were reported in the first issue for July 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

The study recruited 120 patients with evidence of peripheral lung lesions or solitary pulmonary lesions on prior CT scans who were randomly assigned to undergo bronchoscopic diagnosis by one of three techniques: EBUS alone, ENB alone, or ENB and EBUS in combination.

The diagnostic yieldthe percentage of correct diagnosesof each was then analyzed. If these minimally invasive techniques proved inconclusive, a surgical biopsy, the gold-standard for diagnosis, was performed.

The design of the study deserves comment and compliment, wrote Gerard Silvestri, M.D., M.S., in an accompanying editorial. Rarely do we see a prospective, multicenter trial in the field of interventional pulmonology. Rarer still are subjects randomized to different treatment strategies.

EBUS and ENB represent newer technologies that are growing in use. EBUS allows for direct visualization of lesions, but lacks a navigati
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