First assessment of comparative efficacy of virtual bronchoscopy and radial endobronchial ultrasound for minimally invasive diagnosis of peripheral pulmonary lesions

Data regarding the efficacy of virtual bronchoscopy (VB) compared to radial endobronchial ultrasound (rEBUS) for minimally invasive diagnostics of peripheral pulmonary lesions (PPLs) are still controversial.Aim. To assess the comparative efficacy of VB versus VB plus rEBUS in patients with PPLs.Methods. The study enrolled 36 subjects with PPLs detected by chest high resolution computed tomography (HRCT). All patients had bronchoscopy with various biopsy methods (based on navigation) alone or in combination with each other, followed by cytological, histological (if the biopsy sample was available), and microbiological analysis of the specimens. The subjects were randomized into two groups depending on the navigation technique: VB + rEBUS group (I) and VB group (II). VB (Osirix) was done as a planning procedure before real bronchoscopy with rEBUS navigation (Olympus UM-S20-17S) in group I. In group II VB was the only navigation technique.Results. Overall diagnostic yield (d. y.) reached 60% and 56% for groups I and II, respectively. In group I, the d.y. reached 86% for malignancy and 42% for other benign diseases. In group II, the d.y. reached 100% for malignancy and 36% for other benign diseases. The navigation efficacy was higher in the presence of a draining bronchus sign according to chest HRCT, lesion size more than 20 mm, upper lobe peripheral lesion. In group I, detecting the lesion with the ultrasound radial mini probe was also a predictor of efficacy. In group II, abnormal intraluminal bronchial anatomy according to VB as a sign of central lung cancer was also a predictor of efficacy.Conclusion. Both rEBUS and VB are safe and effective navigation techniques that provide for highly effective minimally invasive diagnosis of PPLs. VB could be a sound alternative when rEBUS is unavailable.