Usefulness of virtual bronchoscopic navigation combined with radial endobronchial ultrasound for 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.

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Diagnostic Value of Virtual Bronchoscopic Navigation Combined With Endobronchial Ultrasound Guided Transbronchial Lung Biopsy for Peripheral Pulmonary Lesions

Technology in Cancer Research & Treatment ◽

10.1177/1533033821989992 ◽

2021 ◽

Vol 20 ◽

pp. 153303382198999

Author(s):

Chunhua Xu ◽

Yan Wang ◽

Li Li ◽

Qi Yuan ◽

Yuchao Wang ◽

...

Keyword(s):

Lung Biopsy ◽

Diagnostic Yield ◽

Operation Time ◽

Transbronchial Lung Biopsy ◽

Endobronchial Ultrasound ◽

Ultrasound Guided ◽

Pulmonary Lesions ◽

X Ray ◽

Significant Difference ◽

Peripheral Pulmonary Lesions

Objective: X-ray guided transbronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) can improve the diagnostic yield of peripheral pulmonary lesions (PPLs), but it needs special requirements. The purpose of this study was to investigate the clinical value of virtual bronchoscopy navigation (VBN) combined with EBUS-TBLB in the diagnosis of PPLs without X-ray guidance. Methods: The 105 patients with PPLs underwent EBUS-TBLB with or without VBN randomly. The diagnostic yield, the operation time and complications were evaluated in the 2 groups. Results: No significant difference was found between the VBN+EBUS group and the EBUS group (76.0% vs. 65.5%, P = 0.287). The operation time of VBN+EBUS group was significantly shorter than that of EBUS group (20.6 ± 12.8 min vs. 28.6 ± 14.3 min, P = 0.023). No severe procedure related complications occurred. Conclusions: VBN can shorten the operation time. The combination of VBN and EBUS-TBLB is a safe and effective diagnosis technique for PPLs.

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

Respiration ◽

10.1159/000515181 ◽

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

Background: 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. Objectives: The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. Methods: 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. Results: 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%; p = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; p = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; p = 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 cm2, respectively. Conclusions: TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

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

Diagnostics ◽

10.3390/diagnostics12010041 ◽

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.

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

10.21203/rs.3.rs-1010979/v1 ◽

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

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

Technology in Cancer Research & Treatment ◽

10.1177/1533033820947482 ◽

2020 ◽

Vol 19 ◽

pp. 153303382094748

Author(s):

Chunhua Xu ◽

Wei Wang ◽

Qi Yuan ◽

Huidi Hu ◽

Li Li ◽

...

Keyword(s):

Lung Biopsy ◽

Malignant Tumors ◽

Diagnostic Yield ◽

Operation Time ◽

Transbronchial Lung Biopsy ◽

Endobronchial Ultrasound ◽

Benign Lesions ◽

Pulmonary Lesions ◽

Site Evaluation ◽

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.

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Radial EBUS combined with a GS and VBN for diagnosis of peripheral lung lesions: a retrospective study

10.21203/rs.3.rs-45673/v1 ◽

2020 ◽

Author(s):

Jian Zhang ◽

Shuo-Yao Qu ◽

Yan Zhang ◽

Yong Zhang ◽

Ming-Ming Wang ◽

...

Keyword(s):

Diagnostic Yield ◽

Operation Time ◽

Pulmonary Lesions ◽

Small Probe ◽

Gene Testing ◽

Endobronchial Ultrasonography ◽

Significant Difference ◽

Total Examination Time ◽

Peripheral Pulmonary Lesions ◽

The Cost

Abstract Background More and more peripheral pulmonary lesions (PPL) have been found following the increased utilization of chest CT in China. But how to identify the nature of PPL accurately, safely and economically is the concern of Chinese doctors. The combination of radial endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation was a deluxe scheme to indicate the pathology of peripheral pulmonary lesions in nation’s current medical level. This study aimed to compare the diagnostic yield, safety and health economics of EBUS-GS-VBN versus radial ultrasonic small probe plus thin bronchoscopy (EBUS) for diagnosis of PPLs. Methods This study was a single-institution retrospective review of PLLs examined by using EBUS-GS-VBN or radial EBUS between March 2018 and September 2018 consecutive. The diagnostic yields, accuracy, operation time, complications, factors influencing the diagnostic outcome, tissue genetic test rate and medical cost were analyzed separately. Results there was no significant difference in the diagnostic yield between the two groups (92.31% vs 88.57%, p = 0.594). Although the searching time of EBUS-GS-VBN was shorter (1.47 ± 0.49 min vs 2.12 ± 1.36 min, p < 0.001), procedure time was extended (24.07 ± 5.53 min vs 17.41 ± 4.38 min, p < 0.001). The diagnosis yield of malignancy and benign disease were equal (84.62% vs 100% and 95.35% vs 84%). There was no difference in the rate of gene testing between the two groups (75% vs 70.58%), while the incidence of Intrapulmonary hemorrhage in the EBUS-GS-VBN group was significantly descended. Moreover, the average expense of EBUS-GS-VBN was higher than that of EBUS-GS (6315 ± 1817 RMB vs 3128 ± 1086RMB). Conclusion When performing TBLB of PLLs, we found EBUS-GS-VBN to be similar to EBUS in accuracy. Although the founding lesion time of EBUS-GS-VBN group were significantly shorter, the total examination time was longer. Furthermore, the complications of EBUS-GS-VBN group were fewer. There was no difference in genetic testing between the two groups. It is worth noting that the cost and radiation exposure was lower of EBUS group patients. Trial registration: retrospectively registered

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