Radial‐EBUS and virtual bronchoscopy planner for peripheral lung cancer diagnosis: How it became the first‐line endoscopic procedure

Abstract

Background Various advanced bronchoscopy methods have been developed to reach peripheral lung lesions (PLL). In a large cohort, we aimed to assess a standardized procedure of first‐line radial‐endobronchial ultrasound (r‐EBUS) and virtual bronchoscopy planner for the diagnosis of peripheral lung cancer. Methods This retrospective, single center study included patients who had r‐EBUS‐guided bronchoscopy for the diagnosis of a PLL between 2008 and 2019. Cases without a final diagnosis of cancer or follow‐up were excluded. Results Between 2008 and 2019, 2735 patients had a r‐EBUS procedure, among whom 1627 had a final diagnosis of cancer and were included in the present study. Over the 12‐year study period, r‐EBUS became the first‐line endoscopic procedure to assess PLL (25% as first‐line bronchoscopy in 2008 vs. 92% in 2019). The frequency of the bronchus sign decreased from 2009 to 2019 (100% to 80%; p = 0.001), whereas US visualization of the lesion remained stable (88%). The median number of biopsies increased from two (2008 to 2014) to four (2015 to 2019) ( p < 0.0001), with the same diagnostic efficiency (74% total and 80% when a bronchus sign was present). Of the 651 adenocarcinomas, molecular analysis was possible in 86%. PD‐L1 expression analysis was possible in 81% of cases. During the study period, the lifetime of the radial probe increased from 57 procedures to 77 procedures/probe. Conclusion Because r‐EBUS and VB planner is easy to perform under local anesthesia, inexpensive and efficient it can be used as a first‐line procedure to assess peripheral lung cancer.

Performance of radial endobronchial ultrasound for peripheral pulmonary lesions without automation technology in tuberculous endemic region: real-world experience in a single institution over 6 years

“…The diagnostic yield of rEBUS for PPL biopsy in our study was consistent with previously reported values, with an overall yield of 78.8% ( 7 , 8 ). In line with previous studies, the presence of a direct (type A) bronchus sign and a concentric rEBUS orientation were strong independent predictors of a successful rEBUS procedure ( 7 , 17 ).…”

“…Meta-analyses have revealed a diagnostic yield of approximately 70.6% for the rEBUS procedure, accompanied by a very low overall complication rate of only 2.8% ( 7 ). Over the years, rEBUS procedure has continued to evolve with the addition of more automation technology to enhance its performance, such as virtual bronchoscopic navigation (VBN) for pre-procedural planning, electromagnetic navigational bronchoscopy (ENB) for real-time tracking, and most recently, the use of robotic bronchoscopy systems ( 8 - 10 ). However, these advanced technologies are not readily available in all parts of the world.…”

Proposal of a novel pipeline involving precise bronchoscopy of distal peripheral pulmonary lesions for genetic testing

“…Genetic mutation testing is becoming increasingly important for lung cancer management, and the usefulness of r-RBUS with guide sheath, conventional virtual bronchoscopic planners (e.g., LungPoint, etc. ), and electromagnetic navigation systems has been reported [8][9][10] . Our results indicate that ultraselective bronchoscopy using ultrathin bronchoscopy combined with precise bronchoscopic planner (DOM) and r-EBUS is also useful for obtaining the volume of small distal PPL samples sufficient for NGS-based tumor analysis, displaying a fairly successful instance of precision medicine by adjustment, from a pathological point of view.…”

Detection of Tumor DNA in Bronchoscopic Fluids in Peripheral NSCLC: A Proof-of-Concept Study

“…During this period, patients with peripheral lung nodules suspicious of lung cancer were routinely subjected to r-EBUS with the GS technique for diagnosis as described elsewhere. 5 , 6 …”

“…Unfortunately, in approximately 30% of cases, these samples are noncontributory for genomic analysis owing to a lack of available tumor tissue. 5 , 6 , 7 In this context, ctDNA analysis could represent an alternative for genomic characterization.…”