Diagnostic Role of Bronchoscopic Brush Biopsy Guided by Thin-Section Computed Tomography in Peripheral Pulmonary Lesions

Abstract

Objective: The diagnosis of peripheral pulmonary lesions (PPLs) is important as they may be malignant. It is difficult to diagnose PPLs in the absence of a diagnostic guiding tool. Computed tomography (CT) thin-section multiplanar reconstruction (MPR) images have been used as an alternative guide for bronchoscopic diagnosis of PPL. In this study, we aimed to investigate the diagnostic efficacy of MPR image guidance for PPL. Methods: Patients with PPL who underwent bronchoscopic brush biopsy guided by thoracic CT thin-section MPR images at our center were retrospectively reviewed. The distance of the lesion to the distal bronchus, the presence of the CT-Bronchus sign, the location of the PPL, and the size of the PPL were recorded from the hospital image record archive. The diagnosis rate was obtained from the procedure records. Results: The study included 92 cases. The mean PPL size was 40 ± 21 mm and the mean distal bronchial lesion distance was 27 ± 19 mm. A total of 49 (53.3%) patients had a positive CT-Bronchus sign. The diagnostic yield of the method was 48.9%. The diagnosis rate was significantly higher in patients with positive CT-Bronchus sign (67.3%) compared to those without (26.7%) (P = 0.001). Factors affecting the diagnosis in the logistic regression analysis were distal bronchial lesion distance, presence of CT-Bronchus sign,and localization of the lesion. Conclusion: CT thin-section MPR images can be used for bronchoscopy guidance in cases with PPL larger than 20 mm and positive CT-Bronchus sign in centers where an interventional radiology unit and other guidance tools are not available.