The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Gildea, Thomas R.; Folch, Erik; Khandhar, Sandeep J.; Pritchett, Michael; LeMense, Gregory P.; Linden, Philip A.; Rickman, Otis B.; Mahajan, Amit; Singh, Jaspal; Cicenia, Joseph; Mehta, Atul C.; Lin, Hui-Ling; Mattingley, Jennifer; Investigators, Navigate Study

doi:10.1097/lbr.0000000000000740

Cited by 30 publications

(20 citation statements)

References 41 publications

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“…While a recent study reported lesion localization of 97% [ 4 ], diagnostic yields remain lower at 83% [ 5 ]. This is likely multifactorial; however, it suggests that despite reaching the lesion with the bronchoscope, biopsy tool strategies are ineffective at acquiring targeted tissue, especially with extraluminal lesions adjacent to the airway [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Oberg

Folch

et al. 2022

Lung

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Purpose Tissue acquisition in lung cancer is vital for multiple reasons. Primary reasons reported for molecular testing failure in lung cancer biopsy specimens include insufficient amount of tumor cells provided and inadequate tissue quality. Robotic bronchoscopy is a new tool enabling peripheral pulmonary lesion sampling; however, diagnostic yield remains imperfect possibly due to the location of nodules adjacent to or outside of the airway. The 1.1-mm cryoprobe is a novel diagnostic tool and accesses tissue in a 360-degree manner, thus potentially sampling eccentric/adjacent lesions. This study examines the diagnostic yield of the cryoprobe compared to standard needle aspiration and forceps biopsy. It additionally evaluates yield for molecular markers in cases of lung cancer. Methods This is a retrospective analysis of 112 patients with 120 peripheral pulmonary lesions biopsied via robotic bronchoscopy using needle aspirate, forceps, and cryobiopsy. Results The overall diagnostic yield was 90%. Nearly 18% of diagnoses were made exclusively from the cryobiopsy sample. Molecular analysis was adequate on all cryobiopsy samples sent. Digital imaging software confirmed an increase in quantity and quality of samples taken via cryobiopsy compared to needle aspirate and traditional forceps biopsy. Conclusion Using the 1.1-mm cryoprobe to biopsy PPN combined with the Ion robotic bronchoscopy system is safe, feasible, and provides more diagnostic tissue than needle aspirates or traditional forceps biopsies. The combination of cryobiopsy with robotic-assisted bronchoscopy increased diagnostic yield, likely due to its 360-degree tissue acquisition which is beneficial when targeting extraluminal lesions adjacent to the airway.

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Section: Introductionmentioning

confidence: 99%

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Oberg

Folch

et al. 2022

Lung

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“…The NAVIGATE post hoc analysis confirmed that in the multimodal approach strategy to the nodule, the aspirating needle and forceps had higher true-positive rates [ 6 , 25 ]. The Acquire registry reported that TBNA improved diagnostic yield when compared with other diagnostic tools, such as forceps biopsy, transbronchial brushing and lavage [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

4D Electromagnetic Navigation Bronchoscopy for the Sampling of Pulmonary Lesions: First European Real-Life Experience

Patrucco

Daverio

Airoldi

et al. 2021

Lung

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Purpose The use of Electromagnetic navigation bronchoscopy (ENB) for the diagnosis of pulmonary peripheral lesions is still debated due to its variable diagnostic yield; a new 4D ENB system, acquiring inspiratory and expiratory computed tomography (CT) scans, overcomes respiratory motion and uses tracked sampling instruments, reaching higher diagnostic yields. We aimed at evaluating diagnostic yield and accuracy of a 4D ENB system in sampling pulmonary lesions and at describing their influencing factors. Methods We conducted a three-year retrospective observational study including all patients with pulmonary lesions who underwent 4D ENB with diagnostic purposes; all the factors potentially influencing diagnosis were recorded. Results 103 ENB procedures were included; diagnostic yield and accuracy were, respectively, 55.3% and 66.3%. We reported a navigation success rate of 80.6% and a diagnosis with ENB was achieved in 68.3% of cases; sensitivity for malignancy was 61.8%. The majority of lesions had a bronchus sign on CT, but only the size of lesions influenced ENB diagnosis (p < 0.05). Transbronchial needle aspiration biopsy was the most used tool (93.2% of times) with the higher diagnostic rate (70.2%). We reported only one case of pneumothorax. Conclusion The diagnostic performance of a 4D ENB system is lower than other previous navigation systems used in research settings. Several factors still influence the reachability of the lesion and therefore diagnostic yield. Patient selection, as well as the multimodality approach of the lesion, is strongly recommended to obtain higher diagnostic yield and accuracy, with a low rate of complications.

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“…Despite the possible benefits, even in expert centers, TBNA is underused in real-world practice [ 15 , 16 , 23 ]. Similarly, for ENB, transbronchial forceps biopsy remains the mainstream modality for tissue sampling followed by needle aspiration [ 14 , 24 , 25 ]. Several studies have suggested a higher diagnostic yield with ENB-guided TBNA than forceps biopsy, while few studies have suggested that using multiple tools may be more effective than single-tool strategies [ 11 , 12 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The sample size was calculated in order to determine a 15% difference in the diagnostic yield between the individual modalities and their combined use owing to the expected better and synergistic diagnostic yield. The estimated difference in the diagnostic yield (67% vs. 82%) is based on previously conducted large-scaled observational studies and meta-analyses that suggested an improved diagnostic yield with the use of needle aspiration and a combination of both modalities [ 11 , 12 , 14 , 16 ]. The calculation was based on this difference in the diagnostic accuracy for equality of paired proportions with a two-sided significance level of 0.05 and 80% power.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of the synergistic impact of needle and forceps biopsy with electromagnetic navigation bronchoscopy: the CONFIDENT-ENB trial design

et al. 2022

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Background Electromagnetic navigation bronchoscopy (ENB) is an emerging advanced imaging-guided bronchoscopy technique for diagnosing peripheral lung lesions. However, the selection strategy for the optimal biopsy device and whether adopting a multi-tool strategy increases the diagnostic yield remains undetermined. The CONFIDENT-ENB trial (NCT05110131) is a prospective randomized study on ENB, performed in a least-invasive setting. The primary aim is to evaluate whether a combination of needle aspiration and forceps biopsy improves the diagnostic performance, and assess the comparative diagnostic value and discordance of the two devices. Methods The trial will recruit 142 participants with lung lesions suspected of malignancy who are eligible for an elective ENB procedure under moderate sedation. Participants will undergo ENB-guided needle aspiration and forceps biopsy in a randomized order without the use of any complementary techniques. All participants will be followed up subsequently for up to 12 months to conclude the final diagnosis of the biopsied lesions. Primary outcomes include the diagnostic yield and sensitivity of each biopsy modality and the diagnostic yield of the combined modalities. Discussion The CONFIDENT-ENB trial will prospectively evaluate the synergistic effectiveness and comparative accuracy of ENB-guided needle aspiration and forceps biopsy in a least-invasive setting. The results are expected to improve our understanding of the optimal tool-selection strategy for ENB. Trial registration: ClinicalTrials.gov (NCT05110131). Prospectively registered on 5 November 2021.

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The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Cited by 30 publications

References 41 publications

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

4D Electromagnetic Navigation Bronchoscopy for the Sampling of Pulmonary Lesions: First European Real-Life Experience

Evaluation of the synergistic impact of needle and forceps biopsy with electromagnetic navigation bronchoscopy: the CONFIDENT-ENB trial design

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