CT-guided Ultrathin Bronchoscopy: Bioptic Approach and Factors in Predicting Diagnosis

Abstract

Background The diagnostic sensitivity of current bronchoscopy for peripheral lung cancer is inadequate because the bronchoscope insertion range is limited and confirmation of the position of the biopsy apparatus at the lesion under X-ray fluoroscopy is inaccurate. The combination of ultrathin bronchoscopy and computed tomography (CT) is effective for solving these problems. Objective This study was a retrospective study analyzing prospectively collected data to identify factors contributing to the diagnosis and the appropriate biopsy method in CT-guided ultrathin bronchoscopy for peripheral lung cancer. Methods The subjects comprised 86 patients (88 lesions) who underwent CT-guided ultrathin bronchoscopy and were finally diagnosed with peripheral lung cancer. We evaluated the diagnostic yield according to specific factors and also according to the sample collection method. Results Sixty-nine lesions were diagnosed as lung cancer, and the diagnostic yield was 78.4% (80.3% in lesions !2 cm in diameter). Multivariate analysis showed that the factors contributing to the diagnosis were the observation range by ultrathin bronchoscopy and the presence/absence of the involved bronchus or pulmonary artery. Pathological evaluation facilitated histological diagnoses in 53 (65.4%) of 81 lesions. In 16 lesions, only the cytological diagnosis was positive. Conclusion CT-guided ultrathin bronchoscopy may be particularly useful for lesions for which the involved bronchus or pulmonary artery can be confirmed, and observation of bronchi of the 6th generation or more is possible. Since the specimen preparation rate is low, the combination of histopathological diagnosis with cytological diagnosis particularly that of the discharge attached to the forceps, is optimal.

Cone‐beam computed tomography versus computed tomography‐guided ultrathin bronchoscopic diagnosis for peripheral pulmonary lesions: A propensity score‐matched analysis

“…It is well known that having a CT bronchus sign is a powerful predictor of TBB success. The diagnostic yield of R‐EBUS cases presented a CT bronchus sign that was 69–84% diagnostic, while CT‐guided cases presented CT bronchus signs that were 58–90% diagnostic 13,20,23–28 . Our diagnostic yield was comparable to those.…”

“…Therefore, it was proposed that by combining electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopic navigation (VBN), computed tomography (CT) guidance, radial endobronchial ultrasound (R‐EBUS), guide sheath (GS) and ultrathin bronchoscope (UTB) alone or in combination with TBB, forceps used in diagnosis may reach the lesion more efficiently, thereby increasing the diagnostic yield. Among the methods mentioned, CT‐guided TBB using UTB under VBN was considered to be one of the most promising methods 9–13 …”

Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial

“…The usefulness of UB may play an important role when it is used with other new modalities such as CT-fluoroscopy or virtual bronchoscopic navigation. The combination of UB and CT-fluoroscopy is reported to have a similar diagnostic yield of 78 % in one study [ 16 ]. Data regarding VB combined with UB are conflicting.…”

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

“…Although there is no official definition of an ultrathin bronchoscope, generally, bronchoscopes with an outer diameter of about ≤3 mm are regarded as ultrathin in published reports. Ultrathin bronchoscopes can be inserted into a peripheral bronchus under direct vision, in contrast to conventional bronchoscopes, and they are useful for lesions difficult to diagnose by conventional bronchoscopy [15]. The diagnostic yield with a combination of VBN and CT-guided ultrathin bronchoscopy was reported to be within the range of 65.4-81.6%, and that for lesions ≤2 cm was between 65.4 and 80.8% [11,16,17].…”

“…Thus, selection of patients is necessary. In addition, combination with cytology is necessary because only a small specimen can be collected using ultrathin bronchoscopy [15]. In ultrathin bronchoscopy, the diagnostic yield increases as the amount of collected specimen is increased through more frequent biopsy [18].…”