Guided Bronchoscopy for the Evaluation of Pulmonary Lesions

Nadig, Tejaswi; Thomas, Nina H.; Nietert, Paul J.; Lozier, Jessica; Tanner, Nichole T.; Memoli, Jessica S. Wang; Pastis, Nicholas J.; Silvestri, Gerard A.

doi:10.1016/j.chest.2022.12.044

Cited by 48 publications

(32 citation statements)

References 130 publications

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“…The pooled diagnostic yield in our meta‐analysis is comparable to previously published studies that reported pooled diagnostic yields of 76.5%–84.3% for RAB 11,14,41 . Despite the comparable results, in previous meta‐analyses, the diagnostic yields in the included studies were defined differently.…”

Section: Discussionsupporting

confidence: 73%

“…The pooled diagnostic yield in our meta-analysis is comparable to previously published studies that reported pooled diagnostic yields of 76.5%-84.3% for RAB. 11,14,41 Despite the comparable results, in previous meta-analyses, the diagnostic yields in the included studies were defined differently. Instead of directly synthesizing the diagnostic yields reported in individual studies, we extracted the actual results of RAB and reconstructed the diagnostic yields according to a uniform definition.…”

Section: Discussionmentioning

confidence: 96%

“…The Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool and the modified signaling questions proposed by Nadig et al were used to assess the quality of included studies by two independent investigators (F.X. and N.C.) 13,14 . Discordance was resolved by consensus.…”

Section: Methodsmentioning

confidence: 99%

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Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Zhang,

Xie,

et al. 2024

Thoracic Cancer

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Robotic‐assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta‐analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta‐analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high‐quality prospective studies still need to be conducted.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 96%

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Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Zhang,

Xie,

et al. 2024

Thoracic Cancer

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“…Despite advances in technology, a recent meta-analysis of 16,389 lesions from 126 studies using guided bronchoscopic techniques noted no significance difference in diagnostic yield prior to 2012 (70.5%) versus after 2012 (69.2%), nor significant differences between different technologies utilized. Notably this analysis had a limited number of studies included that utilized robotic assistance [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal use of three different navigational bronchoscopy systems to sample lung nodules in a single patient

Schwalk¹,

Styrvoky²

2023

Respiratory Medicine Case Reports

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“…In nodules with an intermediate risk of lung cancer (10%–65%), bronchoscopic or transthoracic biopsies are recommended to evaluate further management 4 . Recent studies, however, demonstrated that the diagnostic yield of bronchoscopic procedures is significantly lower in nodules with an intermediate risk of lung cancer (42%) compared to nodules with a high risk of malignancy (77%) 5,6 . Therefore, the need for improved bronchoscopic techniques to diagnose lung nodules is urgent, especially in nodules with an intermediate risk of lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Needle‐based confocal laser endomicroscopy for real‐time granuloma detection

Kramer,

Wijmans,

van Heumen

et al. 2023

Respirology

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Background and ObjectiveNeedle‐based confocal laser endomicroscopy (nCLE) allows real‐time microscopic imaging at the needle tip. nCLE malignancy criteria are used for tool‐in‐lesion confirmation during bronchoscopic lung nodule analysis. However, to date, nCLE criteria for granulomas are lacking. The aim was to identify and validate nCLE granuloma criteria and assess if blinded raters can distinguish malignant from granulomatous nCLE videos.MethodsIn patients with suspected sarcoidosis, nCLE‐imaging of mediastinal lymph nodes was performed during endoscopic ultrasound procedures, followed by needle aspiration. nCLE granuloma criteria were identified by comparison with pathology and final diagnoses. Additionally, nCLE‐videos of granulomatous lung nodules part of prospective trials and clinical care were compared to the proposed nCLE granuloma criteria. Blinded raters validated nCLE videos of sarcoid and reactive mediastinal lymph nodes and malignant and granulomatous lung nodules twice.ResultsGranuloma criteria were identified (brighter‐toned, homogeneous and well‐demarcated lesions) based on nCLE‐imaging in 14 sarcoidosis patients. Raters evaluated 26 nCLE‐videos obtained in lymph nodes (n = 15 sarcoidosis; n = 11 reactive and total of 260 ratings). Granuloma criteria were recognized with 88% accuracy. The inter‐observer (κ = 0.63, 95% CI 0.54–0.72) and intra‐observer reliability (κ = 0.70 ± 0.06) were substantial. Based on 12 nCLE‐videos obtained in lung nodules (n = 4 granulomas, n = 6 malignancy, n = 2 malignancy + granulomas and total of 120 ratings) granuloma and malignancy criteria were recognized with 92% and 75% accuracy.ConclusionnCLE imaging facilitates real‐time granuloma visualization. Blinded raters accurately and consistently recognized granulomas on nCLE‐imaging and distinguished nCLE granuloma criteria from malignancy. Our data show the potential of nCLE as a real‐time bronchoscopic guidance tool for lung nodule analysis.

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Guided Bronchoscopy for the Evaluation of Pulmonary Lesions

Cited by 48 publications

References 130 publications

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Longitudinal use of three different navigational bronchoscopy systems to sample lung nodules in a single patient

Needle‐based confocal laser endomicroscopy for real‐time granuloma detection

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