Bronchoscope Size Selection for Improved Diagnostic Yield in Peripheral Pulmonary Lesions: A Retrospective Study

Introduction There is uncertainty about choosing a bronchoscope size for approaching peripheral pulmonary lesions (PPLs). This study aimed to compare the circumstances of using thick and thin scopes and determine the optimal approach for better diagnostic yields. Methods We retrospectively reviewed patients who underwent bronchoscopy for PPLs with thick or thin bronchoscopes at St. Luke's International Hospital between April 2011 and December 2014. We compared the clinical characteristics of patients with thick and thin bronchoscopes. Results A total of 220 patients underwent bronchoscopy for PPLs; 121 patients (median age 69 years, range 20-94 years) were included. The thick bronchoscope group (n = 67) and thin bronchoscope group (n = 54) were similar in age, sex, and PPL shape and location, but not in size. Diagnostic yield was significantly higher in the thick group (79.1% vs. 59.3%, p = 0.0271). There were no significant differences in the diagnostic yield for upper-lobe PPLs (74.4% vs. 67.6%, p = 0.615), but the thick group had significantly higher diagnostic yields for lower-lobe PPLs (84.6% vs. 43.8%, p = 0.014). When the endobronchial ultrasonography findings were adjacent to or invisible, there were significant differences (75.0% vs. 46.2%, p = 0.0498). Conclusion For PPLs located in the lower lobe or if a probe cannot display a within-position, thick bronchoscopes should be preferentially chosen.