The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta‐analysis

Jiang, Simin; Xie, Fangfang; Mao, Xiaowei; Ma, Haifeng; Sun, Jiayuan

doi:10.1111/1759-7714.13373

Cited by 30 publications

(34 citation statements)

References 46 publications

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“…Our results are in contrast with the findings of a recent meta-analysis by Jiang et al , 26 which revealed that overall diagnostic yield of navigation bronchoscopy was statistically higher than non-navigation bronchoscopy for PPLs. The possible reasons for this contrasting finding are as follows: (1) Jiang et al 26 pooled the results of both observational studies and RCTs in their meta-analysis, which might have overestimated the total effect, especially because observational studies were more vulnerable to selection bias. In addition, they failed to include two RCTs that compared VBNA and NVBNA for diagnosing PPLs.…”

Section: Discussioncontrasting

confidence: 99%

“…This was in line with findings of previous meta-analysis. 26 At the same time, Kato et al demonstrated that the diagnostic yield of small PPL <20 mm in diameter was significantly higher in the VBNA group than in the NVBNA group. 29 The use of VBNA might improve bronchial path selection more accurately and quickly for small lesions, in contrast to larger lesions, which could have several routes to reaching the target lesion.…”

Section: Discussionmentioning

confidence: 97%

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Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

Giri

Puri

Wang

et al. 2021

Ther Adv Respir Dis

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Background: Image-guided bronchoscopy techniques such as virtual bronchoscopic navigation (VBN) has emerged as a means of assisting in the biopsy of peripheral pulmonary lesions. However, the role of VBN-assisted (VBNA) bronchoscopy in the diagnosing of peripheral pulmonary lesions (PPLs) has not been well established. This meta-analysis investigated the diagnostic yield of VBN-assisted versus non-VBN-assisted (NVBNA) bronchoscopy for PPLs. Methods: PubMed, Embase, Cochrane library, and Web of Sciences databases were searched up to and including August 2020 to identify randomized controlled trials (RCTs) evaluating the performance of VBNA compared with an NVBNA group. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI). Results: Six RCTs with 1626 patients were included. The overall diagnostic rate was similar in the VBNA (74.17%) and NVBNA (69.51%) groups, with risk ratio of 1.07 (95% CI: 0.98–1.17). However, in the VBNA group, the total examination time was significantly shorter (MD = −3.94 min, 95% CI: −6.57 to −1.36; p = 0.003) than in the NVBNA group. VBNA had superior diagnostic yield than NVBNA for PPLs ⩽ 20 mm (RR = 1.18, 95% CI: 1.05–1.32). In addition, diagnostic yield according to nature of lesion, lesion location in the lung lobe, distance from the hilum, bronchus sign and complications were similar between VBNA and NVBNA groups. Conclusion: VBNA bronchoscopy did not increase overall diagnostic yield in patients with PPLs compared with NVBNA bronchoscopy. The superiority of VBNA over NVBNA was evident among patients with PPLs ⩽ 20 mm. Future multicenter RCTs are needed for further investigation. The reviews of this paper are available via the supplemental material section.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

Giri

Puri

Wang

et al. 2021

Ther Adv Respir Dis

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“…The diagnostic yield of TBLB for PPLs has significantly improved since multiple guided bronchoscopy technologies have been introduced, including electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopic navigation (VBN), radial endobronchial ultrasound (R‐EBUS), ultrathin bronchoscopy (UTB), and guide sheath (GS) 7 . Guided bronchoscopy has been demonstrated to have good guidance ability in the diagnosis of PPLs with equivalency to fluoroscopy but without the accompanying radiation exposure 8–10 . Yoshikawa et al have reported that EBUS‐GS‐guided bronchoscopy without fluoroscopy is an effective method for diagnosing PPLs using conventional videobronchoscopy 11 .…”

Section: Introductionmentioning

confidence: 99%

Ultrathin bronchoscope combined with virtual bronchoscopic navigation and endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions with or without fluoroscopy: A randomized trial

et al. 2021

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Background Transbronchial lung biopsy (TBLB) is usually performed to obtain a definitive diagnosis for peripheral pulmonary lesions (PPLs). Ultrathin bronchoscopy combined with virtual bronchoscopic navigation (VBN) and radial endobronchial ultrasound (R‐EBUS) are generally considered appropriate diagnostic methods for PPLs; however, they have not yet been explored in combination with fluoroscopy. Therefore, the present prospective randomized controlled trial determined the role of fluoroscopy in ultrathin bronchoscopy combined with VBN and R‐EBUS for the diagnosis of PPLs. Methods Patients with potentially malignant PPLs were enrolled in the study and randomized into fluoroscopy or nonfluoroscopy groups. In both groups, a 3.0‐mm outer and 1.7‐mm internal diameter ultrathin bronchoscope was used for transbronchial lung biopsy combined with R‐EBUS and VBN. In addition, the fluoroscopy group (FG) underwent fluoroscopy, while the nonfluoroscopy group (NFG) did not. Results A total of 126 patients were enrolled and randomized in the study. Among them, 120 patients (60 in the NFG and 60 in the FG) were analyzed. The mean lesion sizes were 26.3 ± 11.4 mm and 29.0 ± 11.3 mm in the NFG and FG, respectively. The diagnostic yield was 73.3% (44/60) in the NFG and 81.7% (49/60) in the FG without statistically significant difference (p = 0.38). No obvious complications occurred in either group. Conclusions Ultrathin bronchoscope combined with VBN and R‐EBUS without fluoroscopy is a feasible and safe diagnostic method for PPLs.

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“…According to the American College of Chest Physicians lung cancer guidelines, the least invasive approach is recommended after considering factors such as the lesion size, nodule location, procedure‐related complications, patient comorbidities, and operator expertise 5 . A flexible bronchoscopic biopsy is useful for visible endobronchial lesions but has shown rates of diagnostic yield between 14% and 69% depending on the lesion size and location 5–7 . In the context of peripheral lung nodules, percutaneous transthoracic needle biopsy (PCNB) has been widely adopted and has sensitivity reaching 90%.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield and safety of biopsy guided by electromagnetic navigation bronchoscopy for high‐risk pulmonary nodules

Choi

Kim

et al. 2021

Thoracic Cancer

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Background Electromagnetic navigation bronchoscopy (ENB) is a useful method to obtain tissue for peripheral lung nodules. We aimed to understand the diagnostic yield and safety profile in high‐risk pulmonary nodules that cannot be accessed by percutaneous transthoracic needle biopsy. Methods In this single‐center retrospective study, we reviewed patients who underwent ENB for high‐risk pulmonary nodules. All procedures were performed under moderate sedation using intravenous midazolam and fentanyl. Results A total of 100 pulmonary nodules in 90 patients were subjected to ENB between October 2018 and May 2020. The median age of the study population was 66 (59–73). The mean diameter of the lung nodules was 27.9 mm. The diagnostic yield of ENB‐guided biopsy was 53.0%. Although the nodule size (odds ratio: 1.055, p = 0.007) and positive bronchus sign (odds ratio: 2.918, p = 0.020) were associated with the diagnostic yield during univariate analysis, nodule size was the only independent variable on the multivariable analysis. Interestingly, the diagnostic yield showed an upward trend after 60 cases, from 45%–65%. Procedure‐related complications were reported in 16 cases; among these, pneumothorax occurred in three cases, and four cases experienced moderate bleeding. No instance of major bleeding or death was linked to ENB‐guided biopsy. Conclusion ENB‐guided biopsy for high‐risk pulmonary nodules demonstrated an acceptable diagnostic yield and good safety profile. Moreover, the diagnostic yield was associated with nodule size and procedure experience.

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The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta‐analysis

Cited by 30 publications

References 46 publications

Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis

Ultrathin bronchoscope combined with virtual bronchoscopic navigation and endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions with or without fluoroscopy: A randomized trial

Diagnostic yield and safety of biopsy guided by electromagnetic navigation bronchoscopy for high‐risk pulmonary nodules

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