Ultrasound-Guided Transbronchial Biopsies of Solitary Pulmonary Nodules less than 20 mm

Objectives: Transbronchial biopsy of solitary pulmonary nodules (SPNs) is usually performed under fluoroscopic guidance, but success varies widely. Endobronchial ultrasound (EBUS) may increase the likelihood of success. We assessed the ability of EBUS-guided transbronchial biopsies to sample SPNs less than 20 mm in diameter. Patients and Methods: All patients seen between 06/2004 and 08/2007 in whom computed tomography identified a SPN less than 20 mm underwent bronchoscopy general anesthesia or moderate sedation for a radial EBUS-guided examination. If a typical ultrasonic picture of solid tissue could be identified, specimens were taken through a catheter with forceps. If the node was not detected within 20 minutes, the procedure was terminated. Results: Of 100 nodules detected in 100 consecutive patients, 67 (mean diameter 15 mm) were visualized with EBUS and biopsied. A diagnosis was established for 46 patients (46%). If the lesion was visualized by EBUS, the diagnostic success was 69% (46/67). The 33 patients whose nodules could not be sampled underwent surgical biopsy. Pneumothorax occurred in 3 patients. Conclusions: For SPNs less than 20 mm that can be detected with ultrasound, EBUSguided transbronchial biopsy is safe and effective.