Localization of Peripheral Pulmonary Lesions Using a Method of Computed Tomography–Anatomic Correlation and Radial Probe Endobronchial Ultrasound Confirmation

Chen, Alexander C.; Loiselle, Andrea; Zhou, Li; Baty, Jack; Misselhorn, David

doi:10.1513/annalsats.201601-069oc

Cited by 28 publications

(14 citation statements)

References 15 publications

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“…18 Improvement in diagnostic yield for eccentric lesions has clinical significance, because eccentric lesions were documented in nearly 40% of patients in this study and in as many as 50% of patients in prior publications. 19 The limitations of this study would be related primarily to the relatively small sample size. As a pilot and feasibility study, the specific aims were to investigate the feasibility of the use of the robotic system in humans safely and the ability to navigate the robotic endoscope to the targeted lesion.…”

Section: Discussionmentioning

confidence: 95%

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Chen

Pastis

Mahajan

et al. 2021

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BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield.

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Section: Discussionmentioning

confidence: 95%

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Chen

Pastis

Mahajan

et al. 2021

Chest

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174

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“…No additional navigational software was used in this study to assist with procedural planning. This bronchial branch reading technique has been well described in literature [7, 8].…”

Section: Methodsmentioning

confidence: 99%

Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions

et al. 2019

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BackgroundRadial endobronchial ultrasound (R-EBUS) is an effective technique in the diagnosis of peripheral pulmonary lesions (PPL). However, lesion orientation with regards to the radial probe remains an important factor for effective biopsy. “Within” orientation was associated with significantly higher diagnostic yield. Cryobiopsy is a novel technique in obtaining larger tissue samples with the frozen tip allowing biopsy in a 360° direction, thus potentially achieving more effective biopsy in eccentrically and adjacently orientated lesions. We aimed to evaluate the performance and safety of transbronchial cryobiopsy versus forceps biopsy in eccentrically and adjacently orientated R-EBUS lesions.MethodsRetrospective review of R-EBUS transbronchial biopsy for PPL over 17 months.Results114 R-EBUS scans were included for analysis during the study period. Forceps biopsy was performed in 76 (66.7%) cases and cryobiopsy in 38 (33.3%) cases. Baseline demographics and lesion characteristics did not differ between the two groups. Median (interquartile range) lesion size was 3.48 (2.63–4.51) cm. Overall, 41.2% of lesions were of eccentric orientation and 15.8% adjacent orientation; only 43% were concentric in orientation. Overall diagnostic yield was 67.5% (77 out of 114). Orientation remained an important factor affecting diagnostic yield. Transbronchial cryobiopsy significantly increased the diagnostic yield in eccentrically and adjacently orientated lesions to 75.0% (18 out of 24), compared to 48.8% (20 out of 41) obtained via forceps biopsy (p<0.05); but not in concentric lesions. Cryobiopsy was associated with more mild and moderate bleeding complications compared to the forceps biopsy group.ConclusionsTransbronchial cryobiopsy under R-EBUS guidance is a safe procedure which potentially increases diagnostic yield in eccentrically and adjacently orientated PPLs.

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“…We thank Dickey and colleagues for their interest in our recently published article on the secreted polymeric mucins levels in the sputum and bronchoalveolar (BAL) fluid of patients with severe chronic obstructive pulmonary disease (COPD) with and without bacterial airway colonization (1). Dickey and colleagues expressed surprise at the high levels of MUC2 in the airways of our patients with COPD, which is contrary to their previous studies (2,3).…”

Section: From the Authorsmentioning

confidence: 76%

“…In addition, a positive correlation was identified among MUC2 levels from sputum and BAL samples from stable patients with COPD (1). Furthermore, sputum MUC2 levels had a direct relationship with FEV 1 % predicted in COPD (1).…”

Section: From the Authorsmentioning

confidence: 89%

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Reply: Measuring Airway Mucin 2 in Patients with Severe Chronic Obstructive Pulmonary Disease with Bacterial Colonization

et al. 2016

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Localization of Peripheral Pulmonary Lesions Using a Method of Computed Tomography–Anatomic Correlation and Radial Probe Endobronchial Ultrasound Confirmation

Abstract: A systematic approach applying CT-anatomic correlation with multiplanar CT scan reconstruction and monoplanar fluoroscopy during procedures can result in an efficient, and successful process for locating peripheral pulmonary lesions.

Cited by 28 publications

References 15 publications

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions

Reply: Measuring Airway Mucin 2 in Patients with Severe Chronic Obstructive Pulmonary Disease with Bacterial Colonization

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