Computed Tomography Bronchus Sign and the Diagnostic Yield of Guided Bronchoscopy for Peripheral Pulmonary Lesions. A Systematic Review and Meta-Analysis

2018 ◽  
Vol 15 (8) ◽  
pp. 978-987 ◽  
Author(s):  
Muhammad S. Ali ◽  
Jaskaran Sethi ◽  
Amit Taneja ◽  
Ali Musani ◽  
Fabien Maldonado
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

scholarly journals Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis

2016 ◽  
Vol 48 (1) ◽  
pp. 196-204 ◽  
Author(s):  
Michele Mondoni ◽  
Giovanni Sotgiu ◽  
Martina Bonifazi ◽  
Simone Dore ◽  
Elena Maria Parazzini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Sampling Technique ◽  
Needle Aspiration ◽  
Lesion Size ◽  
Transbronchial Needle Aspiration ◽  
Pulmonary Lesions ◽  
Site Evaluation ◽  
Peripheral Pulmonary Lesions

Fluoroscopy-guided transbronchial needle aspiration (TBNA) has long been used in the diagnosis of peripheral pulmonary lesions (PPLs), although its diagnostic performance varies considerably.We conducted a systematic review and meta-analysis evaluating the accuracy of TBNA in the diagnosis of PPLs, comparing its diagnostic yield with transbronchial biopsy (TBB) and assessing the main predictors of a successful aspirate.In 18 studies, the overall TBNA yield was 0.53 (95% CI 0.44–0.61). TBNA showed a higher accuracy when directly compared to TBB (0.60 (95% CI 0.49–0.71) versus 0.45 (95% CI 0.37–0.54)). The subgroup analyses documented a higher TBNA yield when the computed tomography (CT) bronchus sign was present (0.70 (95% CI 0.63–0.77) versus 0.51 (95% CI 0.38–0.64)), when rapid on-site evaluation (ROSE) was performed (0.62 (95% CI 0.43–0.79) versus 0.51 (95% CI 0.42–0.60)), in the case of malignant lesions (0.55 (95% CI 0.44–0.66) versus 0.17 (95% CI 0.11–0.24)) and for lesions >3 cm (0.81 (95% CI 0.73–0.87) versus 0.55 (95% CI 0.47–0.63)).Conventional TBNA is a useful sampling technique for the diagnosis of PPL, with a higher diagnostic yield than TBB. The presence of CT bronchus sign, an underlying malignant process, lesion size >3 cm and ROSE employment are predictors of a higher yield.

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.

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 Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

2021 ◽  
Vol 15 ◽  
pp. 175346662110170
Author(s):  
Mohan Giri ◽  
Anju Puri ◽  
Ting Wang ◽  
Guichuan Huang ◽  
Shuliang Guo
Keyword(s):  
Risk Ratio ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Pulmonary Lesions ◽  
Lung Lobe ◽  
Examination Time ◽  
Total Examination Time ◽  
Peripheral Pulmonary Lesions

Background: Image-guided bronchoscopy techniques such as virtual bronchoscopic navigation (VBN) has emerged as a means of assisting in the biopsy of peripheral pulmonary lesions. However, the role of VBN-assisted (VBNA) bronchoscopy in the diagnosing of peripheral pulmonary lesions (PPLs) has not been well established. This meta-analysis investigated the diagnostic yield of VBN-assisted versus non-VBN-assisted (NVBNA) bronchoscopy for PPLs. Methods: PubMed, Embase, Cochrane library, and Web of Sciences databases were searched up to and including August 2020 to identify randomized controlled trials (RCTs) evaluating the performance of VBNA compared with an NVBNA group. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI). Results: Six RCTs with 1626 patients were included. The overall diagnostic rate was similar in the VBNA (74.17%) and NVBNA (69.51%) groups, with risk ratio of 1.07 (95% CI: 0.98–1.17). However, in the VBNA group, the total examination time was significantly shorter (MD = −3.94 min, 95% CI: −6.57 to −1.36; p = 0.003) than in the NVBNA group. VBNA had superior diagnostic yield than NVBNA for PPLs ⩽ 20 mm (RR = 1.18, 95% CI: 1.05–1.32). In addition, diagnostic yield according to nature of lesion, lesion location in the lung lobe, distance from the hilum, bronchus sign and complications were similar between VBNA and NVBNA groups. Conclusion: VBNA bronchoscopy did not increase overall diagnostic yield in patients with PPLs compared with NVBNA bronchoscopy. The superiority of VBNA over NVBNA was evident among patients with PPLs ⩽ 20 mm. Future multicenter RCTs are needed for further investigation. The reviews of this paper are available via the supplemental material section.

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.

scholarly journals MP23: The yield of computed tomography of the head in patients presenting with syncope: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S72-S73
Author(s):  
J.A. Viau ◽  
H. Chaudry ◽  
A. Hannigan ◽  
M. Boutet ◽  
M.A. Mukarram ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Diagnostic Yield ◽  
Case Reports ◽  
Meta Analysis ◽  
Observer Agreement ◽  
Acute Management ◽  
Head Ct ◽  
Inpatient Settings ◽  
Ct Head

Introduction: Syncope accounts for 1-3% of Emergency Department (ED) visits. Previous studies have reported overuse of computed tomography (CT) of the head among syncope patients. Professional organizations including Choosing Wisely have recommended against its use in the absence of high-risk features. However, a review of CT head use among syncope patients and its diagnostic yield has not been previously reported. Methods: We conducted a systematic review using EMBASE, Medline, and Cochrane databases from inception to August 2016. We included studies involving adult syncope patients that reported CT head use and its diagnostic yield during acute management by a two-step process: first title/abstract review and then full-text review of selected articles. We excluded case reports, narrative reviews and those involving children. We collected the proportion of patients who had CT head performed, and its diagnostic yield. Outcomes included identification of acute intracranial conditions (hemorrhage, mass or infarct) that require further management. Two reviewers independently abstracted the data and discrepancies were resolved by consensus. We calculated inter-observer reliability for inclusion in the systematic review using kappa values. We performed meta-analysis for diagnostic yield of the CT head. Results: Fifteen studies with 2,802 syncope patients in four sub-groups (proportion of patients among whom CT head was performed and its yield in ED and inpatient settings; studies that reported only the yield among those with CT head performed; and the use and yield among syncope patients ≥65 years old) were included. The inter-observer agreement for inclusion of final articles for meta-analysis was κ=0.925 [95% CI: 0.861-0.990]. Seven ED studies (n=1,261) reported 55.7% patients (95% CI: 32.1-78.0%) had head CT performed with a yield of 4.0% (95% CI: 2.7-5.6%); 5 studies with 1138 hospitalized patients reported that 38.6% (95% CI: 20.4-58.6%) had head CT with a yield of 1.1% (95% CI: 0.4-2.2%). The yield among studies that report only outcomes for CT head was 2.3% and the yield among patients’ ≥65 years was 7.7%. Conclusion: Our review found that a very high proportion of syncope patients had CT head performed during acute management with a very low diagnostic yield. The yield is higher among patients ≥65 years old. A robust tool to identify patients who require a CT head will reduce unnecessary testing.

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