{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:18:24Z","timestamp":1791883104013,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:00:00Z","timestamp":1689552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Echobronchoscope-guided transbronchial needle aspiration (EBUS-TBNA) is mainly used as the transbronchial approach to hilar\/mediastinal lymph nodes or lesions, for diagnostic or staging purposes. Moreover, the role of linear EBUS-TBNA as a diagnostic tool for central intrapulmonary lesions adjacent to the trachea or the major bronchi is also well established. However, since the tip of the ultrasound probe at the distal end of the echobronchoscope is very thin, it can be wedged through smaller peripheral bronchi, reaching the distal parenchyma and allowing for peripheral pulmonary lesion sampling. The main aim of this retrospective study was to evaluate the diagnostic yield and the safety of EBUS-TBNA in the diagnosis of pulmonary peripheral nodules. The database of the Interventional Pulmonology Unit of Azienda Ospedaliero-Universitaria delle Marche (Ancona, Italy) was evaluated to identify peripheral pulmonary nodules approached by EBUS-TBNA. Thirty patients with a single peripheral pulmonary nodule located peripherally to the subsegmental bronchi of the lower lobes and adjacent to a small bronchus greater than 3 mm in diameter were included in this study. The nodule was visible using endoscopic ultrasound in 28 patients and the diagnosis was obtained via EBUS-TBNA in 26 cases (12 adenocarcinoma, 5 typical carcinoid tumors, 4 hamartoma and 5 metastatic lesions). The diagnostic yield was 86.6% for all 30 patients and 92.8% if only the 28 patients in which the lesion was visualized via echobronchoscopy were considered. No relevant adverse events were observed. We conclude that EBUS-TBNA may be an effective and safe option to sample pulmonary peripheral nodules in selected patients with lower lobe peripheral pulmonary lesions adjacent to small bronchi greater than 3 mm in diameter and reachable with the EBUS-TBNA probe.<\/jats:p>","DOI":"10.3390\/diagnostics13142393","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T01:35:16Z","timestamp":1689644116000},"page":"2393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Possible Use of Linear Echobronchoscope for Diagnosis of Peripheral Pulmonary Nodules"],"prefix":"10.3390","volume":"13","author":[{"given":"Lina","family":"Zuccatosta","sequence":"first","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Gonnelli","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmarco","family":"Gasparini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Region, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Duro","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Region, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Barbisan","sequence":"additional","affiliation":[{"name":"Pathological Anatomy Institute, Polytechnic University of Marche Region, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Goteri","sequence":"additional","affiliation":[{"name":"Pathological Anatomy Institute, Polytechnic University of Marche Region, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Veronesi","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy"},{"name":"Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1067-4696","authenticated-orcid":false,"given":"Rocco","family":"Trisolini","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Unit, Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Gasparini","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"348","DOI":"10.21037\/atm.2019.03.59","article-title":"Diagnosis and management of peripheral pulmonary nodule","volume":"7","author":"Khan","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1056\/NEJMoa1209120","article-title":"Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer","volume":"368","author":"Church","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1159\/000525667","article-title":"Dancing in the dark","volume":"101","author":"Rozman","year":"2022","journal-title":"Respiration"},{"key":"ref_4","first-page":"90","article-title":"Diagnostic management of solitary pulmonary nodule","volume":"48","author":"Gasparini","year":"2010","journal-title":"Eur. Respir. Mon."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/MCP.0000000000000842","article-title":"Bronchoscopic diagnosis of peripheral lung lesions","volume":"28","author":"Gasparini","year":"2022","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1136\/thx.2005.047829","article-title":"Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes","volume":"61","author":"Herth","year":"2006","journal-title":"Thorax"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.lungcan.2005.07.013","article-title":"Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer","volume":"50","author":"Yasufuku","year":"2005","journal-title":"Lung Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.lungcan.2019.06.006","article-title":"The expanding role of endobronchial ultrasound in patients with centrally located intrapulmonary tumors","volume":"134","author":"Kuijvenhoven","year":"2019","journal-title":"Lung Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1087028","DOI":"10.3389\/fmed.2022.1087028","article-title":"Suitability of transbronchial needle aspiration for genotyping peripheral pulmonary tumors","volume":"9","author":"Zuccatosta","year":"2023","journal-title":"Front. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nadig, T.R., Thomas, N., Nietert, P.J., Lozier, J., Tanner, N.T., Wang Memoli, J.S., Pastis, N.J., and Silvestri, G.A. (Chest, 2023). Guided bronchoscopy for the evaluation of pulmonary lesions. An updated Meta-analysis, Chest, in press.","DOI":"10.1016\/j.chest.2022.12.044"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1183\/09031936.02.00032001","article-title":"Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions","volume":"20","author":"Herth","year":"2002","journal-title":"Eur. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1378\/chest.126.3.959","article-title":"Endobronchial Ultrasonography Using a Guide Sheath Increases the Ability to Diagnose Peripheral Pulmonary Lesions Endoscopically","volume":"126","author":"Kurimoto","year":"2004","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1183\/09031936.00075310","article-title":"Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: Systematic review and meta- analysis","volume":"37","author":"Steinfort","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1111\/resp.12980","article-title":"Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis","volume":"22","author":"Ali","year":"2017","journal-title":"Respirology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.21037\/tlcr.2017.01.01","article-title":"Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: A systematic review and meta- analysis","volume":"6","author":"Zhan","year":"2017","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.chest.2019.10.042","article-title":"Sensitivity of Radial Endobronchial Ultrasound-Guided Bronchoscopy for Lung Cancer in Patients with Peripheral Pulmonary Lesions. An Updated Meta-analysis","volume":"157","author":"Zuniga","year":"2020","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Eom, J.S., Mok, J.H., Kim, I., Lee, M.K., Lee, G., Park, H., Lee, J.W., Jeong, Y.J., Kim, W.Y., and Jo, E.J. (2018). Radial probe endobronchial ultrasound using a guide sheath for peripheral lung lesions in beginners. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-018-0704-7"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.lungcan.2008.04.004","article-title":"EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy","volume":"63","author":"Tournoy","year":"2009","journal-title":"Lung Cancer"},{"key":"ref_19","first-page":"939","article-title":"Endobronchial ultraspound-guided Transbronchial Needle Aspiration for the Diagnosis of Central Intrapulmonary Lesions not Visible by Conventional Bronchoscopy","volume":"101","author":"Chaiyakul","year":"2018","journal-title":"J. Med. Assoc. Thai"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1097\/JTO.0b013e31818396b9","article-title":"Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrapulmonary lesions","volume":"3","author":"Nakajima","year":"2008","journal-title":"J. Thorac. Oncol."},{"key":"ref_21","first-page":"15","article-title":"Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of non-lymph node thoracic lesions","volume":"8","author":"Yang","year":"2013","journal-title":"Ann. Thorac. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1159\/000524398","article-title":"Accuracy and Predictors of Success of EUS-B-FNA in the Diagnosis of Pulmonary Malignant Lesions: A Prospective Multicenter Italian Study","volume":"101","author":"Mondoni","year":"2022","journal-title":"Respiration"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1159\/000367900","article-title":"Virtual bronchoscopy navigation for peripheral pulmonary lesions","volume":"88","author":"Asano","year":"2014","journal-title":"Respiration"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000355710","article-title":"Diagnostic Yield and Safety of Electromagnetic Navigation Bronchoscopy for Lung Nodules:A Systematic Review and Meta-Analysis","volume":"87","author":"Gex","year":"2014","journal-title":"Respiration"},{"key":"ref_25","first-page":"799","article-title":"Meta-analysis of the diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules","volume":"7","author":"Zhang","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.chest.2020.05.534","article-title":"Sensitivity and Safety of ElectromagneticNavigation Bronchoscopy for Lung Cancer Diagnosis. Systematic Review and Meta-analysis","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/LBR.0000000000000536","article-title":"Cone-Beam CT With Augmented Fluoroscopy Combined With Electromagnetic Navigation Bronchoscopy for Biopsy of Pulmonary Nodules","volume":"25","author":"Pritchett","year":"2018","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"6950","DOI":"10.21037\/jtd.2018.11.21","article-title":"Cone beam computed tomography-guided thin\/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: A prospective pilot study","volume":"10","author":"Casal","year":"2018","journal-title":"J. Thor. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000500228","article-title":"Transbronchial Biopsy Using an Ultrathin Bronchoscope Guided by Cone-Beam Computed Tomography and Virtual Bronchoscopic Navigation in the Diagnosis of Pulmonary Nodules","volume":"98","author":"Ali","year":"2019","journal-title":"Respiration"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1159\/000498951","article-title":"First Human Use of a New Robotic-Assisted Fiber Optic Sensing Navigation System for Small Peripheral Pulmonary Nodules","volume":"98","author":"Fielding","year":"2019","journal-title":"Respiration"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.chest.2020.08.2047","article-title":"Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT)","volume":"159","author":"Chen","year":"2021","journal-title":"Chest"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kumar, A., Caceres, J.D., Vaithilingam, S., Sandhu, G., and Meena, N.K. (2021). Robotic Bronchoscopy for Peripheral Pulmonary Lesion Biopsy: Evidence-Based Review of the Two Platforms. Diagnostics, 11.","DOI":"10.3390\/diagnostics11081479"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"96","DOI":"10.4103\/2303-9027.117695","article-title":"Utility of Narrow Caliber Echo-bronchoscope in Pre-school Pediatric Population: A case series (with video)","volume":"2","author":"Sharma","year":"2013","journal-title":"Endosc. Ultrasound"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/arm91010001","article-title":"Diagnostic accuracy of slow-capillary endobronchial ultrasound needle aspiration in determining PD-L1 expression in non-small cell lung cancer","volume":"91","author":"Zuccatosta","year":"2023","journal-title":"Adv. Respir. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/14\/2393\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:13:35Z","timestamp":1760127215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/14\/2393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,17]]},"references-count":34,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["diagnostics13142393"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13142393","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,17]]}}}