7. Qualitative Analysis of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography

  1. Noriaki Kurimoto MD, PhD Professor of Chest Surgery1,
  2. David I. K. Fielding MB, BS, FRACP, MD Director of Bronchology2 and
  3. Ali I. Musani MD, FCCP, FACP Associate Professor Director3,4

Published Online: 25 NOV 2010

DOI: 10.1002/9781444314366.ch7

Endobronchial Ultrasonography

Endobronchial Ultrasonography

How to Cite

Kurimoto, N., Fielding, D. I. K. and Musani, A. I. (2011) Qualitative Analysis of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography, in Endobronchial Ultrasonography, Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444314366.ch7

Author Information

  1. 1

    Department of Surgery, St Marianna University, Kawasaki City, Kanagawa Prefecture, Japan

  2. 2

    Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

  3. 3

    Interventional Pulmonology, National Jewish Health, USA

  4. 4

    University of Colorado School of Medicine, Denver, CO, USA

Publication History

  1. Published Online: 25 NOV 2010
  2. Published Print: 7 JAN 2011

ISBN Information

Print ISBN: 9781405182720

Online ISBN: 9781444314366



  • Qualitative Analysis of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography;
  • endobronchial ultrasonography (EBUS);
  • transbronchial biopsy (TBB);
  • Correlation between Preoperative EBUS Scans and Histopathological Examination of Peripheral Pulmonary Lesions;
  • Heterogenous Pattern without Hyperechoic Dots or Short Lines


EBUS enables visualisation of the internal structures of peripheral pulmonary lesions, such as vessels, bronchioles, bleeding, calcifications, bronchial dilatation, and necrosis. Very exact correlation of all of these structures has been made in studies correlating EBUS images with matching histopathology sections on resected specimens.

Lesions are typed based on internal echo pattern (homogenous or heterogeneous), vascular patency, and morphology of hyperechoic areas (reflecting the presence of air and the state of the bronchi). For Type I lesions, 92.0% are benign, and 99.0% of Type II and III lesions are malignant. Of Type II lesions, 88.0% are well-differentiated adenocarcinoma, and all Type IIIb lesions were malignant, with 81.8% poorly differentiated adenocarcinoma.

Hosokawa et al. 17 reported that a typical EBUS pattern of neoplastic disease was 1) continuous marginal echo, 2) rough internal echo, 3) no hyperechoic spots representing bronchi, or if present, lacking longitudinal continuity. Kuo et al. 18 assessed the utility of EBUS in differentiating between malignant and benign lesions using the following three characteristic echoic features indicating malignancy: continuous margin, absence of a linear-discrete air bronchogram, and heterogeneous echogenicity.