Evaluation of Pulmonary Nodules Using the Spyglass Direct Visualization System Combined With Radial Endobronchial Ultrasound: A Clinical Feasibility Study

Krystelle Godbout, Simon Martel, Mathieu Simon, Noël Lampron, Antoine Delage*
Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 3120
Abstract HTML Views: 2153
PDF Downloads: 813
ePub Downloads: 675
Total Views/Downloads: 6761
Unique Statistics:

Full-Text HTML Views: 1642
Abstract HTML Views: 1275
PDF Downloads: 526
ePub Downloads: 462
Total Views/Downloads: 3905

Creative Commons License
© Godbout et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Département Multidisciplinaire de Pneumologie et Chirurgie Thoracique, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Québec, Canada, G1V 4G5; Tel: +1-418-656-4747; Fax: +1-418-656-4762; E-mail:



Sampling of peripheral pulmonary nodules with radial endobronchial ultrasound (p-EBUS) increases diagnostic yield of bronchoscopy. However, diagnostic yield is influenced by numerous factors.


We evaluated the use of SpyGlass, a one millimeter diameter optic fiber, to obtain images of the distal mucosa and of pulmonary lesions detected with p-EBUS to determine if visual aspect of the distal mucosa was predictive of diagnosis.


We prospectively recruited subjects investigated for peripheral nodules. Bronchoscopy was performed and p-EBUS was used to locate the lesion through a guide sheath. The Spyglass fiber was introduced in the sheath to obtain images of the distal bronchial mucosa. Tissue sampling was subsequently done.


Fifteen patients were enrolled in the study. A final diagnosis of malignancy was confirmed in 80%. All lesions could be located using p-EBUS (100%). Diagnostic sensitivity for p-EBUS was 58.3%. Distal mucosa could be imaged with SpyGlass in 14/15 patients (93.3%). Mucosal appearance was described as abnormal in 7 out of the 15 subjects. Mean SpyGlass procedure time was 6.5 minutes. No direct complication was reported.


Spyglass can be used in combination with p-EBUS to obtain images of the distal bronchial mucosa and peripheral pulmonary nodules. More patients will be needed to confirm whether mucosal appearance can be predictive of malignancy.

Keywords: Bronchoscopy, Endobronchial ultrasound, Lung cancer, Optic fiber, Peripheral nodule.