Potential of endobronchial ultrasonography (eEBUS) in combination with preliminary CT navigation in the diagnosis of stage I peripheral lung cancer

The problem of differential diagnosis of focal lung lesions remains relevant in Russia and around the world. When a lesion is found in a patient's lung, specialists must answer an important question: is it a malignant tumor? Despite the high sensitivity of radiological diagnostic methods, it is sometimes impossible to definitively rule out the malignant nature of the lesion. Therefore, confirmation is required. This article evaluates the potential of bronchial biopsy of peripheral lung lesions performed under endobronchial ultrasound guidance with preliminary CT navigation. The study aims to evaluate the effectiveness of bronchoscopy with biopsy under endobronchial ultrasound guidance using a radial probe (rEBUS), and to determine the accuracy with which preliminary CT navigation aids the diagnosis of peripheral lung foci up to 3 cm in size. Materials and methods. The study involved 179 patients with peripheral lung lesions measuring no more than 3 centimeters in diameter. The main group comprised 89 patients, while the control group comprised 90 patients. Both groups were comparable in terms of patient age, lesion size and structure, relationship to the bronchi, and lesion location. Prior to bronchoscopy, CT navigation was performed in each case to determine the most suitable route from the lobar bronchus to the bronchus leading to the lesion. Bronchoscopy with biopsy was then performed under endoscopic ultrasound guidance using a radial mini-probe. Results. The combined use of CT navigation and rEBUS achieved an overall success rate of 62.9% (56 out of 89 patients) for the collection of informative morphological material, which was statistically significantly higher than the control group (30.0%; +32.9%) (p < 0.001). Conclusion. The combined technique of CT navigation and rEBUS is a highly effective diagnostic tool that significantly improves the results of bronchoscopic biopsies of peripheral lung lesions. This method is most effective for solid lesions larger than 1 cm, particularly when visualizing the 'afferent' bronchus.