Identification of cytokines in benign and malignant thymus tumors: based on Mendelian randomization and proteomics.

Objective: The aim of this study was to identify potential causal cytokines in thymic malignancies and benign tumors from the FinnGen database using Mendelian randomization (MR). Methods: In this study, data from genome-wide association studies (GWAS) of 91 cytokines were used as exposure factors, and those of thymic malignant tumors and thymic benign tumors were the outcome variables. Two methods were used to determine the causal relationship between exposure factors and outcome variables: inverse variance weighting (IVW) and MR-Egger regression. Sensitivity analysis was performed using three methods, namely, the heterogeneity test, the pleiotropy test, and the leave-one-out test. Results: There was a causal relationship between the expression of fibroblast growth factor 5, which is a risk factor for thymic malignant tumors, and thymic malignant tumors. C-C motif chemokine 19 expression, T-cell surface glycoprotein CD5 levels, and interleukin-12 subunit beta levels were causally related to thymic malignant tumors and were protective. Adenosine deaminase levels, interleukin-10 receptor subunit beta expression, tumor necrosis factor (TNF)-related apoptosis-inducing ligand levels, and TNF-related activation-induced cytokine levels showed a causal relationship with thymic benign tumors, which are its risk factors. Caspase 8 levels, C-C motif chemokine 28 levels, interleukin-12 subunit beta levels, latency-associated peptide transforming growth factor beta 1 levels, and programmed cell death 1 ligand 1 expression showed a causal relationship with thymic benign tumors, which are protective factors. Sensitivity analysis showed no heterogeneity. Conclusion: Cytokines showed a causal relationship with benign and malignant thymic tumors. Interleukin-12 subunit beta is a common cytokine that affects malignant and benign thymic tumors.

Postoperative Dexmedetomidine Infusion and Chronic Postsurgical Pain in Thoracoscopic Pulmonary Nodule Surgery: A Retrospective Study with Propensity-Score-Matched Analysis.

INTRODUCTION: Patients frequently suffer from debilitating chronic postsurgical pain (CPSP) subsequent to thoracoscopic surgery. The impact of postoperative dexmedetomidine infusion on CPSP remains elusive. This study aimed to scrutinize the effect of dexmedetomidine on both 1-year incidence of CPSP and the quality of recovery after thoracoscopic pulmonary nodule surgery. METHODS: This retrospective analysis encompassed clinical and follow-up data from 1148 patients undergoing thoracoscopic pulmonary nodule surgery at our institution between September 2021 and August 2022. Depending on whether dexmedetomidine was infused intravenously or not on the first night after surgery, patients were stratified into the dexmedetomidine group or the control group, with propensity score matching applied to harmonize baseline characteristics. Comparative analysis sought to delineate distinctions of CPSP and recovery quality 1 year after surgery. RESULTS: Following propensity score matching, a cohort of 258 patients in each group underwent analysis. Comparisons after matching revealed no statistically significant disparities in 1-year CPSP incidence [76/258 (29.5%) versus 78/258 (30.2%), P = 0.847], moderate-to-severe pain occurrence [17/76 (22.4%) versus 22/78 (28.2%), P = 0.405], neuropathic pain occurrence [11/76 (14.5%) versus 11/78 (14.1%), P = 0.948], and postoperative recovery quality assessed by 12-Item Short Form Health Survey (SF-12) score (113.1 [107.2, 116.0] versus 113.0 [107.4, 116.0], P = 0.328). Multivariate logistic regression analysis encompassing the entire cohort identified being female [odds ratio (OR) 2.10, 95% confidence interval (CI) 1.59-2.79, P < 0.001) and postoperative rescue analgesia (OR 1.47, 95% CI 1.09-1.96, P = 0.010) as risk factors for CPSP, while intraoperative fentanyl dosage (OR 0.92, 95% CI 0.87-0.98, P = 0.006) emerged as a protective factor. CONCLUSION: The prolonged administration of dexmedetomidine did not yield discernible amelioration in either 1-year CPSP or the recovery quality after thoracoscopic surgery. Noteworthy risk factors for CPSP encompassed female sex, postoperative rescue analgesia, and diminished fentanyl dosage intraoperatively.

Evidence based on Mendelian randomization: Causal relationship between mitochondrial biological function and lung cancer and its subtypes.

OBJECTIVE: This study aimed to investigate the causal relationship between mitochondrial biological function and lung cancer, including its subtypes, via MR. METHODS: SNPs significantly associated with lung cancer and its subtypes were employed as instrumental variables. MR-Egger regression, simple mode, weighted mode, simple median, and weighted median, were utilized to determine the causal relationship between the exposure factor and the occurrence of lung cancer and its subtypes. RESULTS: NADH dehydrogenase (ubiquinone) flavoprotein 2 and transmembrane protein 70 were found to have a causal relationship with lung adenocarcinoma, acting as protective factors. The causal relationship between mitochondrial import inner membrane translocase subunit and NADH dehydrogenase (ubiquinone) iron-sulfur protein 4 and small-cell lung cancer was established as a risk factor. NADH dehydrogenase (ubiquinone) 1 beta subcomplex subunit 8 exhibited a causal relationship with small-cell lung cancer, acting as a protective factor. Furthermore, NAD-dependent protein deacylase sirtuin-5 was causally linked to lung squamous cell carcinoma, serving as a protective factor. A funnel plot demonstrated the symmetrical distribution of the SNPs. Thew pleiotroy test (P > 0.05) and "leave-one-out" test validated the relative stability of the results. CONCLUSION: This study established a causal relationship between mitochondrial biological function and lung cancer, including its subtypes.

MiR-1246 is responsible for lung cancer cells-derived exosomes-mediated promoting effects on lung cancer stemness via targeting TRIM17.

The stemness of lung cancer cells contributes to drug resistance, tumor occurrence, progression, and recurrence; however, the underlying mechanisms are still fragmentary. In the present study, it was found that exosomes from cisplatin-resistant cells and spheres derived from lung cancer cells enhanced the stemness of the parental lung cancer cells. Then we screened the upregulated miRNAs in spheres derived from lung cancer cells and cisplatin-resistant lung cancer cells/exosomes compared to that in the parental lung cancer cells. It was found that miR-1246 was remarkably enriched in cisplatin-resistant lung cancer cells/exosomes and spheres. Additionally, inhibition of miR-1246 attenuated the stemness of lung cancer cells induced by exosomes from cisplatin-resistant cells and spheres. Furthermore, TRIM17 was identified to the direct target of miR-1246 in lung cancer cells. Our findings suggest that exosomal miR-1246 could be as a potential target for lung cancer treatment.

LINC01089, suppressed by YY1, inhibits lung cancer progression by targeting miR-301b-3p/HPDG axis.

PURPOSE: LINC01089 is a newly identified lncRNA and rarely reported in human cancers. Our study aimed to investigate its role in lung cancer. METHODS: YY1, LINC01089, and miR-301b-3p levels in lung cancer tissues and cells were assessed using qRT-PCR. Bioinformatics analysis and luciferase reporter, ChIP, and RIP assays were carried out for determining the relationships among YY1, LINC01089, miR-301b-3p, and HPGD. Gain- and loss-of-function assays were carried out to confirm the impacts of LINC01089 and HPDG in lung cancer cells. CCK-8 assay was used to assess cell proliferation rate, and Transwell assay was applied to measure cell invasion and migration. An in vivo tumor model was applied for validating the role of LINC01089. RESULTS: LINC01089 was decreased in lung cancer tissues and cells, and low LINC01089 level predicted a poor clinical outcome. YY1 directly bound to LINC01089 promoter region and inhibited its transcription. LINC01089 knockdown thwarted the proliferation, invasion, and migration capacity of H1299 and A549 cells and aggravated tumor growth. Specifically, LINC01089 functioned as a competing endogenous RNA of miR-301b-3p to modulate HPGD and thereby affected lung cancer progression. CONCLUSION: Our data revealed that LINC01089, directly suppressed by YY1, inhibited lung cancer progression by targeting the miR-301b-3p/HPGD axis. Graphical abstract 1. LINC01089 expression was downregulated in lung cancer tisuues and cell lines, and low LINC01089 levels predicted a poor clinical outcome. 2. LINC01089 knockdown enhanced proliferation, invasion, and migration of H1299 and A549 cells in vitro and promoted lung cancer cell tumorigenesis and metastasis in vivo. 3. LINC01089, directly suppressed by YY1, functioned as a competing endogenous RNA against miR-301b-3p to increase HPGD expression.

Non-intubated uniportal subxiphoid thoracoscopic extended thymectomy for thymoma associated with myasthenia gravis.

BACKGROUND: To describe a technique of non-intubated uniportal subxiphoid thoracoscopic extended thymectomy. METHODS: Data were collected retrospectively. A single 3-cm transverse incision was made below the xiphoid process. This method for extended thymectomy entails adoption of uniportal subxiphoid VATS combined with using of non-intubated anesthesia for thymoma associated with myasthenia gravis. RESULTS: Ten consecutive patients underwent this procedure successfully. Mean operative time was 102.5 min. Conversion to intubated ventilation or thoracotomy was not required. Mean chest tube duration was 3.5 days. Mean postoperative hospital stay was 4.7 days. Histologic examination showed early-stage thymomas. Side effects were rare. Quantitative MG scores decreased during follow-up. CONCLUSIONS: Patients were uneventfully discharged with fast recovery. This technique may merge the potential benefits of a subxiphoid incision and the non-intubated anesthesia protocol.

CHML targeted by miR-199a-3p promotes non-small cell lung cancer cell growth via binding to Rab5A.

Choroideremia-like (CHML) has been demonstrated to be related to the development of urothelial carcinoma, multiple myeloma, and hepatocellular carcinoma. Whereas, the association between CHML and lung cancer remains dimness. CHML expression was analyzed in NSCLC patients from TCGA dataset and evaluated in our collected NSCLC tissues and NSCLC cell lines. The effects of CHML on the proliferation and apoptosis of NSCLC were investigated in A549 and H1299 cells that downregulation of CHML as well as in H1299-induced xenograft mouse model. An upstream miRNA of CHML was further analyzed. Moreover, bioinformatics analysis and co-immunoprecipitation assay were carried out to explore the mechanism of CHML in NSCLC. We found CHML expression was upregulated in NSCLC patients and cell lines compared with their controls. Knockdown of CHML suppressed the viability and BrdU-positive cell number, and elevated the proportion of Tunel-positive cells and levels of Bax/Bcl-2 and cleaved-caspase-3 in NSCLC cells. In mouse models, downregulation of CHML decreased tumor volume and weight, attenuated Ki-67 staining, whereas elevated numbers of Tunel-positive cells, and upregulated levels of Bax/Bcl-2 and cleaved-caspase-3. CHML was demonstrated to be a target of miR-199a-3p. miR-199a-3p inhibitor significantly promoted the proliferation, and attenuated the apoptosis of H1299 cells, which were abrogated by CHML silencing. CHML promoted the proliferation of NSCLC cells via directly binding to Rab5A. Taken together, this study revealed that CHML was an oncogene in NSCLC and it could promote the proliferation and inhibit apoptosis of NSCLC cells through binding to Rab5A. CHML was targeted by miR-199a-3p in this cancer.

A novel pyroptosis-related lncRNA signature for prognostic prediction in patients with lung adenocarcinoma.

Lung adenocarcinoma (LUAD) has been the major cause of tumor-associated mortality in recent years and has a poor prognosis. Pyroptosis is regulated via the activation of inflammasomes and participates in tumorigenesis. However, the effects of pyroptosis-related lncRNAs (PRlncRNAs) on LUAD have not yet been completely elucidated. Therefore, we attempted to systematically explore patterns of cell pyroptosis to establish a novel signature for predicting LUAD survival. Based on TCGA database, we set up a prognostic model by incorporating PRlncRNAs with differential expression using Cox regression and LASSO regression. Kaplan-Meier analysis was conducted to compare the survival of LUAD patients. We further simplified the risk model and created a nomogram to enhance the prediction of LUAD prognosis. Altogether, 84 PRlncRNAs with differential expression were discovered. Subsequently, a new risk model was constructed based on five PRlncRNAs, GSEC, FAM83A-AS1, AL606489.1, AL034397.3 and AC010980.2. The proposed signature exhibited good performance in prognostic prediction and was related to immunocyte infiltration. The nomogram exactly forecasted the overall survival of patients and had excellent clinical utility. In the present study, the five-lncRNA prognostic risk signature and nomogram are trustworthy and effective indicators for predicting the prognosis of LUAD.

Anlotinib as a post-third-line therapy for the treatment of advanced nonsmall cell lung cancer.

There is no standard treatment strategy for the third-line and above treatment of advanced nonsmall cell lung cancer (NSCLC). This study aimed to investigate the effects of anlotinib in patients with NSCLC. Data was collected from a group of advanced lung cancer patients who received anlotinib as a third-line or post-third-line treatment between 2017 and 2019. The Kaplan-Meier method was used to calculate the progression-free survival (PFS) of these lung cancer patients treated with anlotinib. Univariate analysis was performed using the log-rank test. Forest plot was used for subgroup analysis.Our study included 44 patients. Oral anlotinib was used as a third-line treatment to treat 26 patients, and as a fourth-line or multiline treatment in 18 patients. The objective control rate was 5%, the disease control rate was 89%, and the median PFS was 4.0 months with a 95% confidence interval. Common toxicities included anorexia, hypertension, and fatigue. Anlotinib demonstrated promising efficacy and was well tolerated with controlled toxicity in patients with NSCLC.

Alginic acid inhibits non-small cell lung cancer-induced angiogenesis via activating miR-506 expression.

Angiogenesis is a key event in non-small cell lung cancer progression. Alginic acid (AA), a kind of naturally occurring polyuronic acid, is generally enriched in edible brown algae. Recent studies have uncovered its anti-anaphylactic and anti-inflammatory properties. However, the effects of AA on human malignancies remain unknown. Herein, efficient inhibition of AA on NSCLC-induced angiogenesis was observed with tube formation and xenograft models. Subsequent results indicated that AA downregulated the expression of VEGF-A, a key angiogenesis-inducing cytokine. In addition, AA downregulated STAT3, a transcriptional inducer of VEGF-A and increased non-coding RNA miR-506 expression, respectively. Furthermore, miR-506 directly modulated STAT3 relying on base pairing the 3'-UTR in STAT3 mRNA. We also found that abrogation of miR-506 abolished the inhibitory effect of AA on VEGF-A expression and NSCLC-induced angiogenesis. Finally, xenografts experiments also showed that oral administration of AA could significantly attenuate NSCLC angiogenesis, indicated by decreased micro-vessel density (MVD) and the MVD marker CD31 expression in xenografts tissues. Correspondingly, AA treatment also downregulated VEGF-A, STAT3 and increased miR-506 expression in xenografts samples, respectively. Taken together, these results suggested that AA could suppress NSCLC-induced angiogenesis via miR-506/STAT3/VEGF-A axis. .

Feasibility investigation of near-infrared fluorescence imaging with intravenous indocyanine green method in uniport video-assisted thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line.

OBJECTIVES: To investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near-infrared fluorescence imaging with the intravenous indocyanine green (ICG) method or the modified inflation-deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)-based method. METHODS: We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of a preoperative imaging interpretation and analysis system (IQQA-3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by the ICGF-based method or the MID method. The clinical effectiveness and postoperative complications of the two methods were evaluated. RESULTS: An IBL was visible in 98% of patients in the ICGF-based group, even with low doses of ICG. The ICGF-based group was significantly associated with a shorter IBL clear presentation time (23.6 ± 4.4 vs. 23.6 ± 4.4 s) (p < 0.01) and operative time (89.3 ± 31.6 vs. 112.9 ± 33.3 min) (p < 0.01) compared to the MID group. The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF-based group (8/100, 8% vs. 26/98, 26.5%, p = 0.025). There were no significant differences in bleeding volume, chest tube duration, postoperative hospital stays, surgical margin width, and other postoperative complications. CONCLUSION: The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.

Serum macrophage inhibitory cytokine-1 as a clinical marker for non-small cell lung cancer.

The aim of this study was to investigate the value of serum macrophage inhibitory factor-1 (MIC-1) level in patients with non-small cell lung cancer (NSCLC). Serum samples from 296 patients with NSCLC and 240 healthy controls were collected. The levels of serum MIC-1 were determined by ELISA. The serum MIC-1 levels in NSCLC patients were higher than that of the controls (P <.001). Univariate and multivariate Cox regression analysis showed that serum MIC-1 was an independent prognostic indicator of OS and PFS. Serum MIC-1 is a valuable biomarker for the diagnosis and prognosis of NSCLC.

Comparison of Subxiphoid and Intercostal Uniportal Thoracoscopic Thymectomy for Nonmyasthenic Early-Stage Thymoma: A Retrospective Single-Center Propensity-Score Matching Analysis.

OBJECTIVE: The aim of this study was to compare early outcome between intercostal uniportal video-assisted thoracoscopic surgery (IU-VATS) versus subxiphoid uniportal video-assisted thoracoscopic surgery (SU-VATS) in thymectomy for non-myasthenic early-stage thymoma. METHOD: Retrospective analysis of 76 cases completed in our hospital from May 2018 to September 2019 with subxiphoid uniportal thoracoscopic thymectomy; a single incision of ∼3 cm was made ∼1 cm under the xiphoid process. The control group included 213 patients who received intercostal uniportal thoracoscopic thymectomy from August 2015, and propensity score matching was conducted. All patients who were clinically diagnosed with thymic tumor before surgery were treated with thymectomy. Perioperative outcomes between SU-VATS (n = 76) and IU-VATS, n = 76 were compared. RESULT: After propensity score matching, there were no statistically significant differences between the two groups in terms of age, gender, disease stage, maximal tumor size, or other baseline demographic and clinical variables. All operation was successfully completed; there were no significant differences in the operative time (88 vs. 81 minutes, p = 0.63), intraoperative blood loss (55 vs. 46 mL, p = 0.47), postoperative drainage time (2.2 vs. 2.5 days, p = 0.72), and postoperative hospital stay (3.2 vs. 3.4 days, p = 0.78) between the two groups. The visual analog scale (VAS) on postoperative days 1, 3, 7, and 30 was less in the SU-VATS group than that in the IU-VATS group. The VAS on days 60 and 180 did not differ significantly between the two groups. CONCLUSION: Thymectomy using SU-VATS is a feasible procedure; it might reduce early postoperative pain and lead to faster recovery.

The venous thromboembolism prophylaxis in patients receiving thoracic surgery: A systematic review.

OBJECTIVES: Venous thromboembolism (VTE) is a significant and preventable cause of mortality and morbidity in thoracic surgery. It usually deep venous thromboembolism (DVT) and pulmonary thromboembolism (PE). We conducted this article to perform a systematic review on prophylaxis of perioperative VTE in patients undergoing thoracic surgery especially lung surgery and esophageal surgery and to identify potential areas for future research. METHODS: The systematic review we conducted included studies of patients undergoing thoracic surgery especially lung surgery and esophageal surgery RESULTS: The study identified 2621 references. Finally, 22 trials with a total of 9072 patients were included. Only six studies declared that they continued a follow-up after the discharge of the patients. (range: 1-3 months); three studies reported on major bleeding events as an outcome measure, and the incidence varied from 0.8% to 1.6%. Total 346 VTEs occurred, and the overall mean risk of VTE was estimated at 3.8% (range: 0.77-27%). CONCLUSIONS: The evidence for using thromboprophylaxis in thoracic surgery is limited and controversial, predominantly based on clinical consensus. Future research is needed to focus on identifying risk of VTE and providing sufficient evidence with high quality to support clinical strategies concerning the prophylaxis for VTE.

Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage.

BACKGROUND: To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage. METHODS: Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. RESULTS: After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group. CONCLUSIONS: Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

Near-infrared intraoperative imaging with indocyanine green is beneficial in video-assisted thoracoscopic segmentectomy for patients with chronic lung diseases: a retrospective single-center propensity-score matched analysis.

OBJECTIVE: To investigate whether video-assisted thoracoscopic segmentectomy using near-infrared fluorescence imaging had better intersegmental plane visualization and peri-operative outcome in patients with chronic lung diseases. METHODS: Data were collected retrospectively from March 2014 and August 2019. A total of 92 patients with pulmonary nodules underwent near-infrared fluorescence guided uni-port thoracoscopic segmentectomy(NIF-VATS), 149 patients underwent thoracoscopic segmentectomy with inflation-deflation method(ID-VATS). After 1:1 propensity matching, perioperative outcomes between NIF-VATS and ID-VATS was compared. RESULTS: Incision size was 3 cm in both group.Mean operative time was 79 min in NIF-VATS group and 96 min in ID-VATS group. The intersegmental plane was not clear in 33 cases of ID-VATS group, and no clear boundary was found after prolonged waiting time. Emphysema or pulmonary bullae could be found in chest CT scan in these patients, they all were diagnosed as chronic obstructive pulmonary disease. In NIF-VATS group, the intersegmental plane was not clear in 8 cases. Under the guidance of three-dimensional reconstruction and preoperative positioning, the oncological margin length of both groups met the requirements of surgical quality control. The intraoperative blood loss, number of lymph node resection, showed no statistical difference between the two groups. Postoperative air leakage was more often observed in ID-VATS group. The postoperative drainage duration, postoperative hospitalization time was shorter in ID-VATS group. CONCLUSIONS: Compared with inflation-deflation method, segmentectomy using NIF imaging is feasible for patients with chronic lung diseases with better intersegmental plane, shorter operation time, less complications, it might lead to faster recovery.

Prognostic significance of serum osteopontin levels in small cell lung cancer.

BACKGROUND: Osteopontin (OPN) is closely related to tumor occurrence and metastasis. This study explored the clinical value of serum OPN levels in small cell lung cancer (SCLC) patients. METHODS: The ELISA method was used to determine the OPN level of 96 SCLC patients before and after first-line chemotherapy, and compared with 60 healthy controls. RESULTS: The serum OPN level of SCLC patients before treatment was significantly higher than that of the healthy control (P < 0.001). Serum OPN levels were related to disease stage, tumor size, and lymph node metastasis (P = 0.012, 0.034, and 0.037, respectively). Serum OPN level decreased after first-line chemotherapy (P = 0.019), which was related to treatment response (P = 0.011). The serum OPN level was an independent predictor of overall survival. CONCLUSIONS: The serum OPN level can be used as a biomarker to predict treatment response and survival of SCLC patients.

Rapid On-Site Evaluation During Radial Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy for the Diagnosis of Peripheral Pulmonary Lesions.

OBJECTIVE: To evaluate the diagnostic value of radial endobronchial ultrasound (R-EBUS) combination with rapid on-site evaluation (ROSE) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions. METHODS: Peripheral pulmonary lesions identified by computed tomography underwent R-EBUS with or without ROSE randomly from February 2016 to August 2017. The diagnostic yield and the operation time were compared. RESULTS: In total, 158 patients were involved in and completed this research, including 84 cases in the group of R-EBUS with ROSE, and 74 in the group without ROSE. The diagnostic yield of ROSE group was 85.7%. Among these positive cases, 69.4% cases were malignant tumors, and 30.6% cases were benign lesions. The operation time was (24.6 ± 6.3) min. In the group without ROSE, the diagnostic yield was 70.3%, including 35 malignant tumors (67.3%), and 17 benign lesions (32.7%). The operation time was (31.5 ± 6.8) min. There were significant differences between both groups in the diagnostic yield (χ2 = 5.556, P = 0.018) and in the operation time (t = 3.187, P < 0.01). No serious procedure related complications were observed, such as pneumothorax and hemorrhage. CONCLUSION: ROSE can improve the diagnostic yield, and shorten the operation time. R-EBUS combined with ROSE is a safe and effective technique for peripheral pulmonary lesions.