الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Peripheral pulmonary lesions (PPLs) are commonly seen in clinical practice.Surgical biopsy is the most accurate diagnostic method, Video-assisted thoracoscopic surgery (VATS) is appropriate for suspected malignant PPLs but it is invasive process. Ultrathin bronchoscopes (external diameter less than 3 mm) can be advanced to more peripheral bronchi; they can be advanced to sixth-generation bronchi and it can be used for lesions difficult to be diagnosed by conventional bronchoscopy. The aim of this study was to assess safety and the diagnostic yield of TBLB using ultrathin bronchoscope with VBN and CBCT in comparison to TBLB using conventional fibroptic bronchoscope with use of C-arm guidance and CT- guided transthoracic biopsy and aspiration in diagnosis of peripheral pulmonary lesions. The study included three groups of patients with PPL3: group I (40 patients): Patients with PPLs subjected to ultrathin bronchoscopy. It was carried out at bronchoscopy unit, Tokushima University, Japan.
group II (20 patients): Patients with PPLs subjected to conventional bronchoscopy. It was carried out at bronchoscopy unit, Tokushima University, Japan. In group III (40 patients): Patients were subjected to CT guided transthoracic needle biopsy and aspiration from PPLs. It was carried out at chest medicine and diagnostic radiology departments Mansoura University, Egypt. Results: group I included 40 patients, male predominance 65% (26/40) with a mean age of 72.7 ± 9.4. group II included 20 patients, male predominance 75% (15/20) with a mean age of 73.7 ± 7.9. group III included 40 patients with male predominance 75 % (30/40) with a mean age of 55.5 ± 12.8. In group I, mean size was 19.6 ± 5.7 mm (9-29 mm). Most of PPLs in this group were in upper lobes (50%). Solid PPLs were 70% whereas subsolid PPLs were 30%. All PPLs had positive CT bronchus sign (80% type A and 20% type B). In group II, mean size was 37.4±7.9 (11-48mm). Most of PPLs were in upper lobes 65%. Solid PPLs were 80% and subsolid PPLs were20%. CT bronchus sign were positive in all PPLs (50% type A and 50% type B). In group III, size ranged from 13mm to 75 mm (mean 38.7 ± 5.7). Most of PPLs were in lower lobes 47.5%. Solid PPLs were 80% and 20% were subsolid PPLs. After first step diagnosis, the diagnostic yield of group I was high 90 % (36/40). The diagnostic yield of group II was 75% (15/20) and group III was 87.5% (35 / 40). There was no statistically significance among three groups, but if we correlated to PPLs sizes, there was highly statistically significance (P< 0.001). After second step diagnosis, the diagnostic yield in group I was 97.5%, in group II was 100% and in group III was 95%.Conclusion: To improve the diagnostic yield of TBLB we must select patient, the guiding tools to the target and the tools that confirm the status of biopsy instrument. For high diagnostic accuracy, we must select patients with CT bronchus sign for TBLB. For guidance to the target, CBCT is easy, real time technique with good visibility and extrathoracic navigation technique. While EBUS needs more experience and it is not real time. X-ray fluoroscopy is easy, real time with bad visibility. VBN is a good assistant tools to be combined with other procedure to get good results for TBLB.