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The Usefulness of Endobronchial Ultrasonography–guided Transbronchial Needle Aspiration at the Lobar, Segmental, or Subsegmental Bronchus Smaller Than a Convex-type Bronchoscope

Kurimoto, Noriaki MD, PhD, FCCP*; Inoue, Takeo MD, PhD; Miyazawa, Teruomi MD, PhD, FCCP; Morita, Katsuhiko MD, PhD; Matsuoka, Shin MD, PhD§; Nakamura, Haruhiko MD, PhD*

Journal of Bronchology & Interventional Pulmonology: January 2014 - Volume 21 - Issue 1 - p 6–13
doi: 10.1097/LBR.0000000000000020
Original Investigations

Background: Endobronchial ultrasonography–guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for approaching the lesion adjacent to extrapulmonary bronchus. We started to use wedge insertion of a convex endobronchial ultrasound bronchoscope into bronchi narrower than the diameter of the bronchoscope itself to perform EBUS-TBNA. Our objective was to investigate the bronchus in which EBUS-TBNA was possible and safe.

Methods: In this prospective study, we examined 15 lesions that were adjacent to lobar, segmental, or subsegmental bronchi narrower than the 6.9 mm external diameter of the convex scope. The cross-sectional area and maximum, minimum, and mean internal diameters of the airway lumen adjacent to the lesion were calculated using the measurement software. We investigated the airway branch in which EBUS-TBNA was possible, the narrowest airway diameter adjacent to the lesion for which insertion and diagnosis could be performed, the feasibility of puncture, and techniques for ensuring procedural success.

Results: The mean cross-sectional area of the lumen for the 13 lesions that could be punctured was ≥15.9 mm2 and the mean internal diameter was ≥4.5 mm. Cytologic or histologic diagnosis by EBUS-TBNA was possible in 11 of the 15 cases. In 2 of the 4 undiagnosed lesions, the mean internal diameter was <4.5 mm, and the convex scope was unable to reach the lesion. There was no occurrence of complications in any case.

Conclusions: EBUS-TBNA can be performed by inserting a 6.9 mm EBUS bronchoscope into airways with a mean diameter ≥4.5 mm as measured on computed tomography before bronchoscopy.

Departments of *Chest Surgery


Internal Medicine, Division of Respiratory and Infectious Disease, St Marianna University, School of Medicine, Kanagawa

Department of Surgery, Iwakuni Minami Hospital, Iwakuni, Japan

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Noriaki Kurimoto, MD, PhD, FCCP, Department of Chest Surgery, St Marianna University, School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan (e-mail:

Received July 6, 2013

Accepted September 16, 2013

© 2014 by Lippincott Williams & Wilkins.