Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm

Transbronchial biopsy of solitary pulmonary nodules (SPNs) is usually performed under fluoroscopic guidance, but success varies widely. Endobronchial ultrasonography (EBUS) may increase the likelihood of success. The ability of EBUS-guided transbronchial biopsy to sample SPNs of <20 mm in diameter was assessed. All patients seen between June 2004 and August 2007 in whom computed tomography identified a SPN of <20 mm underwent bronchoscopic general anaesthesia or moderate sedation for a radial EBUS-guided examination. If a typical ultrasonographic picture of solid tissue could be identified, specimens were taken through a catheter with forceps. If the node was not detected within 20 min, the procedure was terminated. Of 100 nodules detected in 100 consecutive patients, 67 (mean diameter 15 mm) were visualised using EBUS and biopsy specimens taken. A diagnosis was established for 46 (46%) patients. If the lesion was visualised by EBUS, the diagnostic success was 69% (46 out of 67). The 33 patients whose nodules could not be sampled underwent surgical biopsy. Pneumothorax occurred in three patients. For SPNs of <20 mm that can be detected using ultrasound, EBUS-guided transbronchial biopsy is safe and effective.