Use of an Ultrathin Versus Thin Bronchoscope for Peripheral Pulmonary Lesions: A Randomized Trial

Abstract Background When evaluating peripheral pulmonary lesions, a 3.0-mm ultrathin bronchoscope (UTB) with a 1.7-mm working channel is advantageous with regard to good access to the peripheral airway, whereas a 4.0-mm thin bronchoscope (TB) provides a larger 2.0-mm working channel, which allows the use of various instruments including a guide sheath (GS), larger forceps, and an aspiration needle. This study compared multimodal bronchoscopy using a UTB and a TB with multiple sampling methods for the diagnosis of peripheral pulmonary lesions. Methods Patients with peripheral pulmonary lesions ≤ 30 mm in diameter were recruited and randomized to undergo endobronchial ultrasonography, virtual bronchoscopy, and fluoroscopy-guided bronchoscopy using a 3.0-mm UTB (UTB group) or a 4.0-mm TB (TB group). In the TB group, the use of small forceps with a GS or standard forceps without the GS was permitted. In addition, needle aspiration was performed for lesions into which an ultrasound probe could not be inserted. Results A total of 360 patients were enrolled and 356 were included in the analyses (median largest lesional diameter, 19 mm). The overall diagnostic yield was significantly higher in the UTB group than in the TB group (70.1% vs. 58.7%, respectively, P = .027). The procedure duration was significantly shorter in the UTB group (median 24.8 vs. 26.8 min, respectively, P = .008). The complication rates were 2.8% and 4.5%, respectively (P = .574). Conclusions Multimodal bronchoscopy using a UTB afforded a higher diagnostic yield than that using a TB in diagnosis of small peripheral pulmonary lesions.