scholarly journals Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions

2019 ◽  
Vol 5 (4) ◽  
pp. 00135-2019 ◽  
Author(s):  
Sze Shyang Kho ◽  
Swee Kim Chan ◽  
Mei Ching Yong ◽  
Siew Teck Tie
Keyword(s):  
Diagnostic Yield ◽  
Lesion Size ◽  
Endobronchial Ultrasound ◽  
Bleeding Complications ◽  
Safe Procedure ◽  
Effective Technique ◽  
Tissue Samples ◽  
Forceps Biopsy ◽  
Novel Technique ◽  
Peripheral Pulmonary Lesions

BackgroundRadial endobronchial ultrasound (R-EBUS) is an effective technique in the diagnosis of peripheral pulmonary lesions (PPL). However, lesion orientation with regards to the radial probe remains an important factor for effective biopsy. “Within” orientation was associated with significantly higher diagnostic yield. Cryobiopsy is a novel technique in obtaining larger tissue samples with the frozen tip allowing biopsy in a 360° direction, thus potentially achieving more effective biopsy in eccentrically and adjacently orientated lesions. We aimed to evaluate the performance and safety of transbronchial cryobiopsy versus forceps biopsy in eccentrically and adjacently orientated R-EBUS lesions.MethodsRetrospective review of R-EBUS transbronchial biopsy for PPL over 17 months.Results114 R-EBUS scans were included for analysis during the study period. Forceps biopsy was performed in 76 (66.7%) cases and cryobiopsy in 38 (33.3%) cases. Baseline demographics and lesion characteristics did not differ between the two groups. Median (interquartile range) lesion size was 3.48 (2.63–4.51) cm. Overall, 41.2% of lesions were of eccentric orientation and 15.8% adjacent orientation; only 43% were concentric in orientation. Overall diagnostic yield was 67.5% (77 out of 114). Orientation remained an important factor affecting diagnostic yield. Transbronchial cryobiopsy significantly increased the diagnostic yield in eccentrically and adjacently orientated lesions to 75.0% (18 out of 24), compared to 48.8% (20 out of 41) obtained via forceps biopsy (p<0.05); but not in concentric lesions. Cryobiopsy was associated with more mild and moderate bleeding complications compared to the forceps biopsy group.ConclusionsTransbronchial cryobiopsy under R-EBUS guidance is a safe procedure which potentially increases diagnostic yield in eccentrically and adjacently orientated PPLs.

scholarly journals Diagnostic Value of a New Cryoprobe for Peripheral Pulmonary Lesions: A Prospective Study

2021 ◽  
Author(s):  
Midori Tanaka ◽  
Yuji Matsumoto ◽  
Tatsuya Imabayashi ◽  
Takuya Kawahara ◽  
Takaaki Tsuchida
Keyword(s):  
Prospective Study ◽  
Diagnostic Yield ◽  
Diagnostic Value ◽  
Lesion Size ◽  
Endobronchial Ultrasound ◽  
Pulmonary Lesions ◽  
Single Use ◽  
Peripheral Pulmonary Lesions ◽  
A Prospective Study ◽  
Established Technique

Abstract Background: Cryobiopsy is an established technique that yields larger and higher-quality samples than does a forceps biopsy. However, it remains underutilised in the diagnosis of peripheral pulmonary lesions (PPLs), mainly because of difficulties in handling conventional cryoprobes. A recently introduced single-use cryoprobe with a smaller diameter and more flexibility than conventional ones may improve its diagnostic ability for PPLs. We conducted this prospective study to evaluate the feasibility of transbronchial cryobiopsy in the diagnoses of PPLs, using a new 1.7-mm cryoprobe. Methods: The study included patients with PPLs less than 30 mm in diameter scheduled to undergo bronchoscopy. All the procedures were performed using a combination of virtual bronchoscopic navigation, radial endobronchial ultrasound (R-EBUS) and X-ray fluoroscopy, and all the samples were collected using the cryoprobe alone. Thereafter, we assessed the diagnostic outcomes and safety profiles.Results: A total of 50 patients were enrolled and underwent cryobiopsy. The median lesion size was 20.8 mm (range, 8.2–29.6 mm), and the negative bronchus sign was seen in 34% of lesions. The diagnostic yield was 94% (95% confidence interval, 83.5–98.8%). A positive bronchus sign had a significantly higher diagnostic yield than did a negative bronchus sign (100% vs. 82.4%; P=0.035). The yield was achieved regardless of other variables, including lesion size, location, and R-EBUS findings. The major complications were mild and moderate bleeding in 28% and 62% of patients, respectively. Pneumothorax was identified in one patient.Conclusion: Transbronchial cryobiopsy using the new 1.7-mm cryoprobe is a feasible procedure that has the potential to increase the diagnostic accuracy for PPLs.Trial Registration: Japan Registry of Clinical Trials, jRCT1032200065. Registered 8 July 8 2020, https://jrct.niph.go.jp/en-latest-detail/jRCT1032200065

scholarly journals Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

2015 ◽  
Vol 47 (2) ◽  
pp. 607-614 ◽  
Author(s):  
Daniel P. Steinfort ◽  
Asha Bonney ◽  
Katharine See ◽  
Louis B. Irving
Keyword(s):  
Diagnostic Yield ◽  
Lesion Size ◽  
Endobronchial Ultrasound ◽  
Virtual Bronchoscopy ◽  
Cytologic Examination ◽  
Electromagnetic Navigation ◽  
Pulmonary Lesions ◽  
Relative Contribution ◽  
Peripheral Pulmonary Lesions ◽  
Diagnosis Of Lung Cancer

Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±sd). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5versus19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL–hilum distance or PPL–pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63–76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield.

scholarly journals Usefulness of virtual bronchoscopic navigation combined with radial endobronchial ultrasound for peripheral pulmonary lesions

2020 ◽  
Author(s):  
chunhua xu ◽  
Wei Wang ◽  
YuChao Wang ◽  
Qi Yuan ◽  
ChuanZhen Chi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Yield ◽  
Operation Time ◽  
Diagnostic Value ◽  
Endobronchial Ultrasound ◽  
Effective Technique ◽  
Pulmonary Lesions ◽  
Significant Difference ◽  
Peripheral Pulmonary Lesions

Abstract Background: This study aimed to evaluate the diagnostic value of virtual bronchoscopic navigation combined with radial endobronchial ultrasound for peripheral pulmonary lesions (PPLs). Methods: The 105 patients with PPLs identified by computed tomography in Nanjing Brain Hospital underwent radial endobronchial ultrasound (R-EBUS) with or without virtual bronchoscopic navigation (VBN) randomly from January 2015 to December 2017. The diagnostic yield, operation time and complications were evaluated in the two groups. Results: There was no significant difference in the diagnostic yield between the VBN+R-EBUS group and the R-EBUS group (76.0% vs. 65.5%, P =0.287). The operation time in VBN+R-EBUS group was less than that in R-EBUS group (20.6±12.8 min vs. 28.6±14.3 min, P =0.016). No severe procedure related complications such as pneumothorax and hemoptysis were observed. Conclusions: VBN cannot improve the diagnostic yield, but it can shorten the operation time. The VBN combined with R-EBUS is a safe and effective technique for PPLs.

Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Kai-Lun Yu ◽  
Shun-Mao Yang ◽  
Huan-Jang Ko ◽  
Hui-Yu Tsai ◽  
Jen-Chung Ko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Propensity Score ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

<b><i>Background:</i></b> The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated. <b><i>Objectives:</i></b> The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. <b><i>Methods:</i></b> We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety. <b><i>Results:</i></b> While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; <i>p</i> = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; <i>p</i> = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; <i>p</i> = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm<sup>2</sup>, respectively. <b><i>Conclusions:</i></b> TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

The Diagnostic Yield of Endobronchial Ultrasound With a Guide Sheath in Small Peripheral Pulmonary Lesions

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 845A
Author(s):  
Jamsak Tscheikuna ◽  
Supawadee Makanut ◽  
Supparerk Disayabutr
Keyword(s):  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

scholarly journals Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 41
Author(s):  
Ching-Kai Lin ◽  
Hung-Jen Fan ◽  
Zong-Han Yao ◽  
Yen-Ting Lin ◽  
Yueh-Feng Wen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Diagnostic Yield ◽  
Study Groups ◽  
Transbronchial Biopsy ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Ultrasound Guided ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs.

scholarly journals Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Gonzalo Labarca ◽  
Carlos Aravena ◽  
Francisco Ortega ◽  
Alex Arenas ◽  
Adnan Majid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Endobronchial Ultrasound ◽  
Safe Procedure ◽  
Mediastinal Staging ◽  
Prospective Trials ◽  
Sensitivity Specificity ◽  
Search Quality ◽  
Quality Assessments

Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging.Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging.Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis.Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89%) and the specificity was 99% (CI 98–100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4%) and specificity improved to 100% (CI 99-100%).Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.

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