Combined radiological and endobronchial ultrasonographic control in the diagnosis of peripheral foci of lung formations less than 3 cm in size

Despite significant advances in radiography and endoscopy, the problem of differential diagnosis of peripheral lesions in the lungs remains relevant. Unfortunately, the use of high-resolution CT, post-processing capabilities, and various bronchoscopy methods, including bronchial biopsies, in combination with ultrasonic navigation does not fully solve this problem. This article is devoted to evaluating the capabilities of bronchoscopy with various options for bronchial biopsies of peripheral lesions in the lungs under combined endobronchial ultrasonography and X-ray control with preliminary CT navigation. The aim of the study is to evaluate the effectiveness of bronchoscopy with various types of bronchial biopsy under endobronchial ultrasound using a radial probe (rEBUS) and X-ray control with preliminary CT navigation in the diagnosis of small peripheral focal lesions in the lungs. Materials and methods. The study included patients with focal lesions in the peripheral lungs. The maximum size of the lesions did not exceed 3 cm. The main group included 77 patients, and the control group included 77 patients. The groups were comparable in terms of age, size, structure of the lesions, their relationship to the bronchi, and localization. Before bronchoscopy, CT navigation was used in each case to determine the optimal path to the lesion. Bronchoscopy with various types of bronchial biopsy was performed under endosonography and X-ray guidance. Results. The combination of the three methods resulted in a high overall effectiveness of diagnostic material collection for morphological studies — 70.1% (54 out of 77 patients). This result was statistically significant (p < 0.001). The effectiveness of the methods significantly exceeded that of the control group (+29.8%; 40.3%). Conclusion. The effective combination of CT navigation, rEBUS, and X-ray control is a powerful diagnostic tool that demonstrates high effectiveness in detecting small peripheral lung lesions. This technique combines the advantages of both preoperative planning and intraoperative navigation, making it the preferred method for diagnosing peripheral lesions in the lungs, especially solid lesions larger than 1 cm.