Background: Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial\nultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung\nlesions. In some cases, however, it is difficult to obtain adequate biopsy samples for pathological diagnosis.\nAdequate prediction of the diagnostic accuracy of TBB with EBUS-GS is important before deciding whether\nbronchoscopy should be performed.\nMethods: We retrospectively reviewed 149 consecutive patients who underwent TBB with EBUS-GS for small-sized\nperipheral lung lesions (?30 mm in diameter) from April 2012 to March 2013. We conducted an exploratory\nanalysis to identify clinical factors that can predict an accurate diagnosis by TBB with EBUS-GS. All patients\nunderwent thin-section chest computed tomography (CT) scans (0.5-mm slices), and the CT bronchus sign was\nevaluated before bronchoscopy in a group discussion. The final diagnoses were pathologically or clinically\nconfirmed in all studied patients (malignant lesions, 110 patients; benign lesions, 39 patients).\nResults: The total diagnostic yield in this study was 72.5 % (95 % confidence interval: 64.8ââ?¬â??79.0 %). Lesion size,\nlesion visibility on chest X-ray, and classification of the CT bronchus sign were factors significantly associated with\nthe definitive biopsy result in the univariate analysis. In the multivariate analysis, only the CT bronchus sign\nremained as a significant predictive factor for successful bronchoscopic diagnosis. The CT bronchus sign was also\nsignificantly associated with the EBUS findings of the lesions.\nConclusion: Our results suggest that the CT bronchus sign is a powerful predictive factor for successful TBB with\nEBUS-GS.
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