Biopsy of peripheral pulmonary lesions using real-time radial endobronchial ultrasound and a "double-barrel" bronchoscope.

Endobronchial ultrasound (EBUS) has contributed substantially to the diagnosis of centrally located lesions within the thorax. More recently, this technology has been applied to the diagnosis of peripheral pulmonary lesions. One accepted technique for visualizing peripheral pulmonary lesions using radial EBUS involves use of a guide sheath placed within or adjacent to the lesion after localization using a radial EBUS probe. A diagnostic yield of >70% has been reported using this method, though direct visual feedback of needle aspiration within the mass is still lacking. Under continuous ultrasound guidance, the diagnostic yield of linear array EBUS is higher than 90%. In this case series, we present 3 cases in which transbronchial needle aspiration and forceps biopsy of peripheral pulmonary lesions were performed under continuous radial EBUS guidance using a modified "double-barrel" bronchoscope.