Introduction Peripheral pulmonary mass lesions are common findings in respiratory medicine. The frequency of detection of such lesions is rising with increasing availability of radiological imaging techniques. Their aetiology may need to be established by tissue sampling to facilitate appropriate management, for example, suspected malignancy. Traditional investigations include CT-guided biopsy, bronchoscopic biopsy, endoscopic ultrasound with fine needle aspiration (EBUS/EUS) and surgical intervention. Each modality has potential complications, for example, pneumothorax following CT-guided biopsy. Endoscopic ultrasound miniprobe is established as a valuable tool, particularly in the staging of early GI tumours and in extraductal visualisation of the biliary tract. EBUS-MP has been used for qualitative assessment of bronchial mural structures in lung transplant recipients but little is known about the role of EBUS-MP sampling of peripheral pulmonary mass lesions. The purpose of this paper is to demonstrate our experience with this technique to date.
Methods All EBUS-MP procedures were carried out over a 6-month period in a tertiary respiratory centre. Patients were referred for suspected malignancy. All procedures were undertaken by the same consultant bronchoscopist, assisted by a respiratory trainee. An Olympus UM-S20-17S 1.7 mm Miniprobe® was identify the target lesion. Samples (biopsies or endobronchial brushings) were then taken from the identified subsegmental bronchus. Each case was subsequently reviewed with respect to diagnostic rate, subsequent management, complications and potential alternative investigations to EBUS-MP.
Results 24 EBUS-MP procedures were performed on 22 patients (Age range 53–82 years (mean 70.4 years)). FEV1 ranged from 0.8 L to 2.9 L. 20 of 22 CT-identified lesions (14–60 mm) were visualised with EBUS-MP. No complications occurred in study population. Abstract S40 Figure 1 shows detailed outcomes for EBUS-MP.
Conclusions EBUS-MP is a novel technique in bronchoscopy. Our early experience has demonstrated some potential usefulness of the procedure, allowing good visualisation of lesions. No complications have occurred to date. We believe that EBUS-MP sampling may have a role in investigation of peripheral pulmonary mass lesions. In a well selected cohort of patients it appears to be a safe alternative to CT-guided biopsy.