Clinical Study Diagnosis of Peripheral Lung Lesions via Conventional Flexible Bronchoscopy with Multiplanar CT Planning Marianne Anastasia De Roza, 1 Kien Hong Quah, 1 Cheong Kiat Tay, 1 Weiquan Toh, 1 HuiHua Li, 2 Ganesh Kalyanasundaram, 1 and Devanand Anantham 1 1 Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore 2 Division of Research, Singapore General Hospital, Singapore Correspondence should be addressed to Devanand Anantham; anantham.devanand@sgh.com.sg Received 20 March 2016; Revised 29 September 2016; Accepted 11 October 2016 Academic Editor: Kazuyoshi Kuwano Copyright © 2016 Marianne Anastasia De Roza et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Conventional fexible bronchoscopy has limited sensitivity in the diagnosis of peripheral lung lesions and is dependent on lesion size. However, advancement of CT imaging ofers multiplanar reconstruction facilitating enhanced preprocedure planning. Tis study aims to report efcacy and safety while considering the impact of patient selection and multiplanar CT planning. Method. Prospective case series of patients with peripheral lung lesions suspected of having lung cancer who underwent fexible bronchoscopy (forceps biopsy and lavage). Endobronchial lesions were excluded. Patients with negative results underwent CT-guided transthoracic needle aspiration, surgical biopsy, or clinical-radiological surveillance to establish the fnal diagnosis. Results. 226 patients were analysed. Te diagnostic yield of bronchoscopy was 80.1% (181/226) with a sensitivity of 84.2% and specifcity of 100%. In patients with a positive CT-Bronchus sign, the diagnostic yield was 82.4% compared to 72.8% with negative CT-Bronchus sign ( = 0.116). Diagnostic yield was 84.9% in lesions > 20 mm and 63.0% in lesions ≤ 20 mm ( = 0.001). Six (2.7%) patients had transient hypoxia and 2 (0.9%) had pneumothorax. Tere were no serious adverse events. Conclusion. Flexible bronchoscopy with appropriate patient selection and preprocedure planning is more efcacious in obtaining a diagnosis in peripheral lung lesions compared to historical data. Tis trial is registered with ClinicalTrials.gov Identifer: NCT01374542. 1. Introduction Te diagnosis of peripheral lung lesions in patients who are suspected of having lung cancer remains a challenge. Te overall diagnostic sensitivity of conventional bronchoscopic lung biopsy in these patients is reported at approximately 57% [1]. Te diagnostic yield is afected by the combined use of sampling techniques such as forceps, washing, and needle aspiration, as well as number of samples obtained, size of the lesion, and the presence of computed tomography- (CT-) Bronchus sign that is the presence of an airway leading directly into the pulmonary lesion [2, 3]. An alternative diagnostic modality is CT-guided transthoracic needle aspiration/biopsy that has a pooled diagnostic sensitivity of approximately 90% [4]. Te complications associated with this procedure include a high pneumothorax rate of 15% (chest tube insertion rate of 6.6%). Pulmonary hemorrhage rate is less common at 1% but up to 18% of these patients required blood transfusion. Air embolism, tumor seeding, and chest wall hematoma have also been reported [5]. Furthermore, in many institutions, CT-guided transthoracic needle aspiration can only be performed in an inpatient setting. Tese limitations have spurred the development of navigational bronchoscopy technology to improve the diagnostic yield of a bronchoscopic approach while retaining its benefts that is relatively low complication rate and performed in an outpatient setting. Tese technologies include radial endobronchial ultrasound (EBUS), virtual navigation bronchoscopy, and electromagnetic navigation. Despite showing some promise, the diagnostic yield of these techniques have plateaued at 67–73% [6]. Tere is also an associated monetary cost to these advanced techniques and a learning curve for the endoscopists. Hindawi Publishing Corporation Pulmonary Medicine Volume 2016, Article ID 5048961, 7 pages http://dx.doi.org/10.1155/2016/5048961