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Original Research Comparison of the Thin Convex Probe Endobronchial Ultrasound Bronchoscope to Standard Endobronchial Ultrasound and Flexible Bronchoscope—A Cadaveric Study Sean P Callahan, 1 Nichole T Tanner, 1,2 Alexander Chen, 3 Thierry Bacro, 4 Gerard A Silvestri 1 and Nicholas J Pastis 1 1. Department of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC, US; 2. Ralph H Johnson Veterans Affairs Hospital, Charleston, SC, US; 3. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, US; 4. Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, US B ackground: Convex probe endobronchial ultrasound (CP-EBUS) with transbronchial needle aspiration (TBNA) is used to sample mediastinal and hilar lymph nodes and is considered a gold standard for mediastinal staging of lung cancer. Current technology is limited in ability to sample lesions located away from the mediastinum. The aim of this study was to evaluate the range of a new thin convex probe EBUS prototype in a cadaveric model and compare its accessibility into distal airways to that of a standard flexible and CP-EBUS bronchoscope using a cadaveric model. Methods: Three separate bronchoscopes were used and compared: standard bronchoscope (Olympus BF-H190), linear CP-EBUS bronchoscope (Olympus BF-UC180F), and the thin CP-EBUS bronchoscope. (Olympus BF-Y0055). Each bronchoscope was inserted sequentially into a male and female cadaver. The number of bronchial generation accessible was recorded and compared using fluoroscopy. A polymer was created and inserted into various airways to simulate lesions, which were then localized and sampled. Results: The TCP-EBUS prototype demonstrated improved accessibility of distal airways when compared to CP-EBUS bronchoscope. In the male and female cadaver the TCP-EBUS bronchoscope accessed an additional generation and in most instances accessed the same distal airways as a standard bronchoscope. Conclusion: The thin convex probe-EBUS bronchoscope can extend further into the distal airways than the traditional CP-EBUS bronchoscope and can achieve a reach similar to a standard bronchoscope, thus allowing the potential to bring real-time biopsy capability to areas of the lung that currently cannot be reached by standard convex probe-EBUS. Keywords Endobronchial ultrasound, convex probe, thin convex probe, bronchoscopy, cadaver Disclosure: Nichole T Tanner is currently receiving grant funding and consulting fees from Olympus America, Inc. and Cook Inc. Alexander Chen is currently receiving research funding and consulting fees from Olympus America, Inc. Gerard A Silvestri and Nicholas J Pastis are currently receiving grant funding from Olympus America, Inc. Sean P Callahan and Thierry Bacro have no conflict of interest or source funding to declare. The abstract was presented at Advancements in Lung Cancer Diagnostics and Treatment Session; American College of Chest Physicians Chest Annual Meeting 2016; Chest. 2016;150 (Suppl. 4):979A. Compliance with Ethics: All procedures were performed under the guidance of the institutional review board of the Medical University of South Carolina (Pro#37817). Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: October 17, 2016 Accepted: December 13, 2016 Citation: US Respiratory & Pulmonary Diseases, 2017;2(1):33–6 Corresponding Author: Sean P Callahan, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 816, MSC 630, Charleston, South Carolina 29425, US. E: callahse@musc.edu Assessment of peripheral pulmonary nodules and mediastinal lymph nodes is critical in the diagnosis and staging of lung cancer, which is the leading cause of cancer death worldwide. 1,2 Endobronchial ultrasound (EBUS) continues to evolve, allowing clinicians the ability to evaluate peripheral and central pulmonary lesions as well as various layers of bronchi. Current EBUS bronchoscopes are larger and less maneuverable than a standard bronchoscope, which limits their ability to access certain regions of the lung. Convex probe endobronchial ultrasound (CP-EBUS) with transbronchial needle aspiration (TBNA) is used to sample mediastinal and hilar lymph nodes and is considered a first-line test for mediastinal staging of lung cancer. 3 It is an effective, safe, and minimally invasive procedure, which can also diagnose sarcoidosis and lymphoma. 4,5 While CP-EBUS provides access to mediastinal nodes and centrally located pulmonary lesions, it is limited in its ability to sample lesions located more distal to the central airways. A 35° forward oblique direction of view, the diameter of the scope, and the inability to flex the scope at an acute angle make it particularly difficult for the CP-EBUS bronchoscope to navigate into the upper lobes and the narrow right middle lobe (RML) orifice. 6 An alternative to the CP-EBUS is radial EBUS (r-EBUS), which can reach the periphery of the lung; however, lack of ‘real-time’ ultrasound during needle puncture is a limiting factor. Support: The study was supported by a grant from Olympus America, Inc. These limitations led to the development of the thin CP-EBUS (TCP-EBUS) (OLYMPUS MEDICAL SYSTEMS CORP, Tokyo, Japan) to perform real-time TOU CH MED ICA L MEDIA 33