PT  - JOURNAL ARTICLE
AU  - Minoru Inomata
AU  - Naoyuki Kuse
AU  - Nobuyasu Awano
AU  - Mari Tone
AU  - Hanako Yoshimura
AU  - Tatsunori Jo
AU  - Jonsu Minami
AU  - Kohei Takada
AU  - Yutaka Muto
AU  - Kazushi Fujimoto
AU  - Akinori Harada
AU  - Yuan Bae
AU  - Toshio Kumasaka
AU  - Hideaki Yamakawa
AU  - Shintaro Sato
AU  - Kazunori Tobino
AU  - Hidekazu Matsushima
AU  - Tamiko Takemura
AU  - Takehiro Izumo
TI  - Utility of radial endobronchial ultrasonography combined with transbronchial lung cryobiopsy in patients with diffuse parenchymal lung diseases: a multicentre prospective study
AID  - 10.1136/bmjresp-2020-000826
DP  - 2021 Jan 01
TA  - BMJ Open Respiratory Research
PG  - e000826
VI  - 8
IP  - 1
4099  - http://bmjopenrespres.bmj.com/content/8/1/e000826.short
4100  - http://bmjopenrespres.bmj.com/content/8/1/e000826.full
SO  - BMJ Open Resp Res2021 Jan 01; 8
AB  - Background Radial endobronchial ultrasonography (R-EBUS) has been used in conjunction with transbronchial lung cryobiopsy (TBLC) to diagnose diffuse parenchymal lung disease (DPLD) and to decrease the risk of bleeding complications. The diagnostic utility of different R-EBUS signs, however, remains unknown.Objectives This study aimed to determine whether different R-EBUS signs could be used to more accurately diagnose DPLD and whether bronchial bleeding could be prevented with use of R-EBUS during TBLC.Method Eighty-seven patients with DPLD were included in this multicentre prospective study, with 49 patients undergoing R-EBUS. R-EBUS signals were characterised as displaying either dense or blizzard signs. Pathological confidence of specimens obtained from TBLC was compared between patients with dense versus blizzard signs, and severity of bronchial bleeding was determined based on whether R-EBUS was performed or not.Results All patients with dense signs on R-EBUS showed consolidation on high-resolution CT (HRCT) imaging. Pathological confidence of lung specimens was significantly higher in patients with dense signs versus those with blizzard signs (p<0.01) and versus those who did not undergo R-EBUS (p<0.05). Patients who underwent TBLC with R-EBUS were more likely to experience no or mild bronchial bleeding than patients who did not undergo R-EBUS (p<0.01), with shorter procedure times (p<0.01).Conclusions The dense R-EBUS sign corresponded with consolidation on HRCT. High-quality lung specimens may be obtainable when the dense sign is observed on R-EBUS, and R-EBUS combined with TBLC may reduce risk of bronchial bleeding and shorten procedure times.Data are available upon reasonable request. The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.