Um s20 20r

In the group 3 (patients performed EBUS-GS), equipped with endoscopic ultrasound system (EU-M30S, Olympus, Tokyo, Japan), a 20 MHz radial small-diameter probe (UM-S20–20R Olympus) with guide sheath was inserted through the working channel of the bronchoscope. Once the precise location of the lesion was identified by EBUS, the probe was withdrawn, leaving the GS in place. Subsequently, the specimen were harvested through the brushing, forceps biopsy, and BALF for ROSE and pathologic diagnosis as other groups.

The procedure was performed by chest fellows under the supervision of experienced pulmonologists. Conventional bronchoscopy with a 2.0-mm working channel (BF-P260F bronchoscope; Olympus, Tokyo, Japan) was first conducted to inspect the bronchial trees, after local anaesthesia with 5 ml of 2% lidocaine sprayed or nebulized into the upper airway mucosa and intramuscular injection of meperidine 50 mg if not contraindicated.[14 (link), 15 (link)] Additional 1–2 ml of 2% lidocaine were instilled onto the larynx, carina and second carina following insertion of the bronchoscope. EBUS was then performed with an endoscopic ultrasound centre (EU-M30S; Olympus) and a 20-MHz radial-type ultrasonic probe (UM-S20-20R; Olympus). After locating the PPLs on the EBUS images, EBUS-guided TBB was performed as described previously.[16 (link)] The biopsy procedures were repeated until at least 2 adequate samples were retrieved. Bronchial washing or brushing was conducted after TBB, based on the judgment of the pulmonologists in charge. Other ancillary bronchoscopic techniques, including guiding sheath, ultrathin bronchoscopy, fluoroscopy, virtual bronchoscopic navigation, electromagnetic navigation, and rapid on-site evaluation, were not applied in this study.

Bronchoscopy was carried out with a flexible bronchoscope (BF‐1T260; Olympus) under local anesthesia. For patients receiving EBUS‐TBLB, ultrasound analysis was carried out employing an EBUS system (processor EU‐ME2; Olympus), equipped with a 20 MHz mechanical radial miniprobe (UM‐S20‐20R; Olympus). A thorough examination of the target bronchus with the bronchoscope was performed. Once the target PPL was localized, we measured the distance between it and the outer orifice of the bronchoscope working channel for the purpose of performing TBLB at the same PPL site. Subsequently, the miniprobe was withdrawn, and biopsy forceps were inserted into the bronchoscope working channel to acquire five or more biopsy specimens in the same location and depth indicated by the minprobe.²⁰ In addition, bronchial brushes were introduced routinely to acquire the cytological specimens. The final diagnosis of EBUS‐TBLB was based on the pathological and cytological specimens. All procedures were performed by experienced thoracic surgeons who possessed at least five years of experience in bronchoscopy.

All ENB procedures were performed using the SuperDimension^TM navigation system version 7.1 (Medtronic, Minneapolis, MN, USA). All additional procedural decisions, including choice of biopsy tools (forceps, needle, cytobrushes, bronchial lavage), order of biopsy tool use and use of fluoroscopy (confirmed with frontal images), were performed at the operator’s discretion. In all three centers, intravenous Midazolam and Fentanyl were used for sedation, and all procedures were performed using Olympus (190F) bronchoscopes, rEBUS probes were Olympus UMS20-20R and forceps were Olympus FB-231D.
The location of the lesions (central, middle, peripheral) were recorded based on the definition used in the NAVIGATE study [15 (link)], with peripheral lesions defined as lesions in the peripheral outer third of the lungs and the central lesions located in proximity to the hilum.
All operators used rEBUS as a standardized part of the ENB procedure whenever possible. There was no access to rapid onsite evaluation of cytological material (ROSE). All procedures were performed under conscious sedation and any adverse events related to the procedures were recorded. None of the pulmonologists had access to supervision by experienced ENB operators.

Conventional bronchoscopy (BF-P260F or BF-P290; Olympus, Tokyo, Japan) was initially performed to examine the trachea and bronchi. R-EBUS was then performed using an endoscopic ultrasound center (EU-M30S; Olympus) and a 20-MHz radial ultrasonic probe (UM-S20-20R; Olympus). The R-EBUS probe position was recorded as within or adjacent to the target tumor. After a lesion was located, the radial probe was withdrawn from the working channel of the bronchoscope, and the R-EBUS procedure consisting of transbronchial biopsy, bronchial brushing, and bronchial washing was then performed.