Comparison of bronchoscopic diagnosis for peripheral pulmonary nodule under fluoroscopic guidance with CT guidance.

BACKGROUND: A new diagnostic procedure has been established for the selection of appropriate therapy for small lung lesions. We compared the sensitivity of real-time multi-slice computed tomography (MSCT) and X-ray television (TV) fluoroscopic guidance for performing bronchoscopy.

METHODS: The first author performed and interpreted all bronchoscopies described in this study. The diagnosis of malignancy or benign was based on the results of histopathological examination, as well as clinical and imaging follow-up MSCT. We also compared the diagnostic yields of lesion size between MSCT and X-ray TV fluoroscopic guidance.

RESULTS: Real-time MSCT and X-ray TV fluoroscopic guidance was conducted in 82 and 78 patients, respectively. The lesion size detected by real-time MSCT and X-ray TV fluoroscopic guidance was <10 mm (n=21, 14), 11-15 mm (n=24, 12), 16-20 mm (n=19,14), 21-25 mm (n=9, 12) and >26 mm (n=9, 26). The sensitivity of real-time MSCT- and X-ray TV fluoroscopic guidance was 62.2% and 52.6%, respectively. The sensitivity of real-time MSCT fluoroscopic guidance for histopathologic diagnosis of lesions less than 15 mm was higher than that of X-ray TV fluoroscopic guidance. While it was difficult to histopathologically diagnose small lung lesions less than 10mm in diameter, real-time MSCT fluoroscopic guidance offers a better chance of such diagnosis, irrespective of the size of the lesion, compared with X-ray TV fluoroscopic guidance.

CONCLUSION: Real-time MSCT fluoroscopic guidance allows the bronchoscopist to accurately determine the location of the instruments in relation to the lesion in real time, thus helping to reduce the number of negative cases.