2019 Volume 41 Issue 5 Pages 457-462
Background. When the disease of a patient with non-small cell lung cancer (NSCLC) and an epidermal growth factor receptor (EGFR) mutation progresses after EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy, it is important to perform a re-biopsy for reliable tissue collection. However, there are some cases in which a re-biopsy by bronchoscopy is difficult. Case. A 47-year-old man with pulmonary adenocarcinoma (stage IVA) and an EGFR mutation (exon 19 deletion) was diagnosed with an increase in primary tumor size after EGFR-TKI therapy. We performed endobronchial ultrasonography (EBUS) using a guide sheath (GS) for a re-biopsy. When the bronchial lumen was observed with an ultra-thin bronchoscope (BF-XP260F), it was found to be obstructed by a white sub-epithelial lesion. When we used a thin bronchoscope (BF-P260F) and inserted an ultrasound probe, the lesion was occluded at the entrance, and no additional probes could be inserted. The brush could be inserted through the GS at the same site into the lesion under fluoroscopic guidance. When we re-inserted the ultrasound probe, EBUS showed that the probe was located within the lesion. The histopathological diagnosis revealed adenocarcinoma positive for EGFR mutations (exon 19 deletion and exon 20 T790M). Conclusion. We experienced a case in which the method of performing EBUS-GS with a brush was useful for collecting reliable tissue by a re-biopsy when a peripheral bronchus was obstructed at the margin of a lesion.