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Tamiya M et?al. combined pEBUS with guide sheath (GS), thin bronchoscope and LungPoint (Broncus Medical, Inc. Mountain View, CA, USA), a virtual bronchoscopic navigation system for small pulmonary nodules.[87] Sixty-eight consecutive patients were recruited and LungPoint was used to identify the bronchus leading to the pulmonary nodule. Overall, diagnostic yield was 77.9%; 83.7% for malignancy and 68.0% for benign disease. Univariate and multivariate analyses showed that pEBUS localization was Tryptophan synthase the most significant contributor to diagnostic yield especially if the probe was within the lesion (92%) compared with adjacent to the lesion (60%). In another study,[88] pEBUS-GS was performed first to localize peripheral pulmonary lesions, with as needed ENB if pEBUS-GS failed. Sixty patients were enrolled, average lesion size was 27?mm and mean pleural distance was 20?mm. pEBUS detected 75% of peripheral pulmonary lesions. Addition of ENB improved lesion visualization to 93%. However, diagnostic yields for pEBUS and combined pEBUS with ENB were not statistically different (43% vs 50%). Predictive factors for ENB were smaller peripheral pulmonary lesions and absent CT air bronchus sign. Although PD98059 molecular weight ENB improved localization, it was not adequate to achieve diagnosis, and improvements in sampling methods could bridge the gap between localization and diagnosis.[89] Fruchter O et?al. evaluated a novel sampling technique in a group of lung transplant recipients.[90] Bronchoscopic lung biopsies remain the gold standard for assessment of allograft rejection or infection. Forty patients underwent cryo-transbronchial biopsies and were matched against 40 controls with forceps-transbronchial biopsies. There were no major complications. The mean diameter of cryo-biopsy was 10?mm against 2?mm with forceps-transbronchial biopsies (P?selleckchem addition, fluoroscopy time was shorter in patients undergoing cryo-biopsy compared with controls (25?s vs 90?s, P?
