{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:56:21Z","timestamp":1785776181279,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T00:00:00Z","timestamp":1710806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"2022 Yeungnam University Research Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Diagnosing ground-glass opacity (GGO) pulmonary lesions poses challenges. This study evaluates the utility of radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) in diagnosing GGO pulmonary lesions. A total of 1651 RP-EBUS procedures were performed during the study period. This study analyzed 115 GGO lesions. The EBUS visualization yield was 80.1%. Of 115 lesions, 69 (60%) were successfully diagnosed. The average size of diagnosed lesions was significantly larger than that of undiagnosed lesions (21.9 \u00b1 7.3 vs. 17.1 \u00b1 6.6 mm, p &lt; 0.001). Diagnostic yield varied by lesion size: 50.0% for lesions &lt;20 mm, 65.1% for 20\u201330 mm lesions, and 85.7% for lesions &gt;30 mm. The mixed blizzard sign on EBUS appeared in 60.6% of mixed GGO lesions, with no cases in pure GGO lesions. Multivariable analyses showed that lesion size (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.00\u20131.16; p &lt; 0.001) and mixed blizzard sign on EBUS (OR, 20.92; CI, 7.50\u201358.31; p &lt; 0.001) were significantly associated with diagnostic success. Pneumothorax and hemoptysis occurred in 1.7% and 2.6% of patients, respectively. RP-EBUS-TBLB without fluoroscopic guidance is a viable diagnostic approach for GGO pulmonary lesions with acceptable complications.<\/jats:p>","DOI":"10.3390\/cancers16061203","type":"journal-article","created":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T09:39:31Z","timestamp":1710841171000},"page":"1203","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Ground-Glass Opacity Pulmonary Lesions without Fluoroscopic Guidance"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7204-6700","authenticated-orcid":false,"given":"Jongsoo","family":"Park","sequence":"first","affiliation":[{"name":"Department of Radiology, Yeungnam University Medical Center, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changwoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Geol","family":"Jang","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Soo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Soo","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7104-8325","authenticated-orcid":false,"given":"June Hong","family":"Ahn","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"National Lung Screening Trial Research Team, Aberle, D.R., Adams, A.M., Berg, C.D., Black, W.C., Clapp, J.D., Fagerstrom, R.M., Gareen, I.F., Gatsonis, C., and Marcus, P.M. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med., 365, 395\u2013409.","DOI":"10.1056\/NEJMoa1102873"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"National Lung Screening Trial Research Team, Church, T.R., Black, W.C., Aberle, D.R., Berg, C.D., Clingan, K.L., Duan, F., Fagerstrom, R.M., Gareen, I.F., and Gierada, D.S. (2013). Results of initial low-dose computed tomographic screening for lung cancer. N. Engl. J. Med., 368, 1980\u20131991.","DOI":"10.1056\/NEJMoa1209120"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.jtho.2023.06.014","article-title":"Lung Cancer Screening in Asia: An Expert Consensus Report","volume":"18","author":"Lam","year":"2023","journal-title":"J. Thorac. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.jtcvs.2019.10.145","article-title":"Results of low-dose computed tomography as a regular health examination among Chinese hospital employees","volume":"160","author":"Zhang","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3348\/kjr.2007.8.1.22","article-title":"Nodular ground-glass opacities on thin-section CT: Size change during follow-up and pathological results","volume":"8","author":"Lee","year":"2007","journal-title":"Korean J. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1148\/radiol.2017161659","article-title":"Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017","volume":"284","author":"MacMahon","year":"2017","journal-title":"Radiology"},{"key":"ref_7","unstructured":"American College of Radiology (2014). Lung CT Screening Reporting and Data System (Lung-RADS), American College of Radiology."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/JTO.0000000000000019","article-title":"Correlation between the Size of the Solid Component on Thin-Section CT and the Invasive Component on Pathology in Small Lung Adenocarcinomas Manifesting as Ground-Glass Nodules","volume":"9","author":"Lee","year":"2014","journal-title":"J. Thorac. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1007\/s00330-015-4017-4","article-title":"Persistent pulmonary subsolid nodules with solid portions of 5 mm or smaller: Their natural course and predictors of interval growth","volume":"26","author":"Lee","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5119","DOI":"10.1007\/s00330-017-4917-6","article-title":"CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: Experience at a single tertiary hospital","volume":"27","author":"Lee","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.1016\/j.ejrad.2011.03.088","article-title":"Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions","volume":"79","author":"Yamauchi","year":"2011","journal-title":"Eur. J. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kim, J., Chee, C.G., Cho, J., Kim, Y., and Yoon, M.A. (2021). Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: A systematic review and meta-analysis. Br. J. Radiol., 94.","DOI":"10.1259\/bjr.20210065"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1080\/07357907.2016.1212061","article-title":"Preoperative Percutaneous Transthoracic Needle Biopsy Increased the Risk of Pleural Recurrence in Pathological Stage I Lung Cancer Patients With Sub-pleural Pure Solid Nodules","volume":"34","author":"Kashiwabara","year":"2016","journal-title":"Cancer Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1159\/000362885","article-title":"Endobronchial Ultrasonography with a Guide Sheath for Pure or Mixed Ground-Glass Opacity Lesions","volume":"88","author":"Ikezawa","year":"2014","journal-title":"Respiration"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4103\/atm.ATM_428_16","article-title":"Predictive factors for a successful diagnostic bronchoscopy of ground-glass nodules","volume":"12","author":"Nakai","year":"2017","journal-title":"Ann. Thorac. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4046\/trd.2021.0002","article-title":"Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy","volume":"84","author":"Hong","year":"2021","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1183\/09031936.00167914","article-title":"Radial endobronchial ultrasound images for ground-glass opacity pulmonary lesions","volume":"45","author":"Izumo","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Yamagami, T., Yoshimatsu, R., Miura, H., Yamada, K., Takahata, A., Matsumoto, T., and Hasebe, T. (2013). Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions. Br. J. Radiol., 86.","DOI":"10.1259\/bjr.20120447"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yang, J.S., Liu, Y.M., Mao, Y.M., Yuan, J.H., Yu, W.Q., Cheng, R.D., Hu, T.Y., Cheng, J.M., and Wang, H.Y. (2014). Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions. Br. J. Radiol., 87.","DOI":"10.1259\/bjr.20140276"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1016\/j.athoracsur.2005.06.074","article-title":"Risk of pleural recurrence after needle biopsy in patients with resected early stage lung cancer","volume":"80","author":"Matsuguma","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.lungcan.2017.07.008","article-title":"Ipsilateral pleural recurrence after diagnostic transthoracic needle biopsy in pathological stage I lung cancer patients who underwent curative resection","volume":"111","author":"Moon","year":"2017","journal-title":"Lung Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.athoracsur.2010.12.032","article-title":"Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients","volume":"91","author":"Inoue","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cho, J., Ko, S.-J., Kim, S.J., Lee, Y.J., Park, J.S., Cho, Y.-J., Yoon, H.I., Cho, S., Kim, K., and Jheon, S. (2014). Surgical resection of nodular ground-glass opacities without percutaneous needle aspiration or biopsy. BMC Cancer, 14.","DOI":"10.1186\/1471-2407-14-838"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kim, Y.T. (2022). Management of ground-glass nodules: When and how to operate?. Cancers, 14.","DOI":"10.3390\/cancers14030715"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1093\/icvts\/ivu233","article-title":"Therapeutic surgery without a definitive diagnosis can be an option in selected patients with suspected lung cancer","volume":"19","author":"Ozeki","year":"2014","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1111\/1759-7714.13493","article-title":"Definitive lobectomy without frozen section analysis is a treatment option for large or deep nodules selected carefully with clinical diagnosis of malignancy","volume":"11","author":"Mori","year":"2020","journal-title":"Thorac. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"340","DOI":"10.6004\/jnccn.2023.0020","article-title":"NCCN Guidelines\u00ae Insights: Non-Small Cell Lung Cancer, Version 2.2023","volume":"21","author":"Ettinger","year":"2023","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"754","DOI":"10.6004\/jnccn.2022.0036","article-title":"NCCN Guidelines\u00ae Insights: Lung Cancer Screening, Version 1.2022","volume":"20","author":"Wood","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.athoracsur.2016.09.001","article-title":"Usefulness of Endobronchial Ultrasonography With a Guide Sheath and Virtual Bronchoscopic Navigation for Ground-Glass Opacity Lesions","volume":"103","author":"Ikezawa","year":"2017","journal-title":"Ann. Thorac. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/6\/1203\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:15:56Z","timestamp":1760105756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/6\/1203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,19]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["cancers16061203"],"URL":"https:\/\/doi.org\/10.3390\/cancers16061203","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,19]]}}}