Transbronchial Diagnosis of A Pulmonary Peripheral Small Lesion Using an Ultrathin Bronchoscope with Virtual Bronchoscopic Navigation

Asano, Fumihiro; Matsuno, Yoshihiko; Matsushita, Tomomichi; Kondo, Hirohito; Saitō, Yoshio; Seko, Akira; Ishihara, Yoichiro

doi:10.1097/00128594-200204000-00007

Cited by 61 publications

(31 citation statements)

References 7 publications

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“…Navigational bronchoscopy does not merely refer to various displayed CT data, but links these data and the actual patient information obtained in real time during bronchoscopy to guide the bronchoscope and biopsy instruments. Currently, virtual bronchoscopic navigation (VBN) [6] and electromagnetic navigation (EMN) [7] are used in clinical practice, and exclusive devices are sold for each system. These systems are similar with regard to the use of 3-dimensional CT display and virtual bronchoscopy; however, virtual bronchoscopic (VB) images are used in different ways, and EMN also makes use of an electromagnetic sensor [8].…”

Section: Introductionmentioning

confidence: 99%

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

2014

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Virtual bronchoscopic navigation (VBN) is a method in which the bronchoscope is guided on the bronchial route to a peripheral lesion using virtual bronchoscopic images. In reports on VBN for peripheral pulmonary lesions searched in PubMed as of November 2013, the diagnostic yield by ultrathin bronchoscopy in combination with computed tomography and VBN was within the range of 65.4-81.6%. Using endobronchial ultrasonography with a guide sheath (EBUS-GS) and VBN, it was between 63.3 and 84.4%, and using X-ray fluoroscopy and VBN, it was between 62.5 and 78.7%. The overall diagnostic yield was 73.8% [95% confidence interval (CI) 70.9-76.8%] and that for lesions ≤2 cm was 67.4% (95% CI 63.3-71.5%). These values indicate high diagnostic rates. In randomized comparative trials, the combination of VBN with EBUS-GS improved the diagnostic yield and shortened the examination time. The diagnostic yields for lesions in the right upper lobe, those invisible on posterior-anterior radiographs and those located in the peripheral third of the lung field were improved by VBN on ultrathin bronchoscopy in combination with X-ray fluoroscopy. The usefulness of VBN was also found on meta-analysis. Taken together, VBN is a promising navigational bronchoscopy method as it requires no specific training, has a low overall complication rate of 1.0% (95% CI 0.2-1.8%) and does not directly induce or cause severe complications. To maximize the full potential of VBN and promote its use, investigation of cases in which it is useful, determination of the optimum combination of procedures, a cost/benefit analysis and advancement of the VBN system are warranted.

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Section: Introductionmentioning

confidence: 99%

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

2014

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“…Virtual bronchoscopic navigation (VBN) is a method in which virtual bronchoscopy (VB) images of the bronchial path to the peripheral lesion are produced and used as a guide to navigate the bronchoscope (8,9). In order to confirm the arrival of the bronchoscope at the lesion site, it is necessary to combine VBN with another procedure.…”

Section: Introductionmentioning

confidence: 99%

Virtual Bronchoscopic Navigation Improves the Diagnostic Yield of Radial-Endobronchial Ultrasound for Peripheral Pulmonary Lesions with Involved Bronchi on CT

et al. 2015

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Objective Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful. Methods The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterioranterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated. Results Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026). Conclusion VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.

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“…Ultrathin bronchoscopes are useful for the diagnosis of peripheral pulmonary lesions, particularly those in S1 and S1+2, into which insertion of conventional bronchoscopes is limited (10). To make use of this advantage, we have proposed a method in which a bronchoscope is navigated using virtual bronchoscopic images en route to the lesion (virtual bronchoscopic navigation: VBN) (11). For a method that combines measures addressing the two abovementioned problems stated, Kobayashi et al reported CTguided ultrathin bronchoscopy (12).…”

Section: Introductionmentioning

confidence: 99%

CT-guided Ultrathin Bronchoscopy: Bioptic Approach and Factors in Predicting Diagnosis

Matsuno¹,

Asano²,

Shindoh

et al. 2011

Intern. Med.

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Background The diagnostic sensitivity of current bronchoscopy for peripheral lung cancer is inadequate because the bronchoscope insertion range is limited and confirmation of the position of the biopsy apparatus at the lesion under X-ray fluoroscopy is inaccurate. The combination of ultrathin bronchoscopy and computed tomography (CT) is effective for solving these problems. Objective This study was a retrospective study analyzing prospectively collected data to identify factors contributing to the diagnosis and the appropriate biopsy method in CT-guided ultrathin bronchoscopy for peripheral lung cancer. Methods The subjects comprised 86 patients (88 lesions) who underwent CT-guided ultrathin bronchoscopy and were finally diagnosed with peripheral lung cancer. We evaluated the diagnostic yield according to specific factors and also according to the sample collection method. Results Sixty-nine lesions were diagnosed as lung cancer, and the diagnostic yield was 78.4% (80.3% in lesions !2 cm in diameter). Multivariate analysis showed that the factors contributing to the diagnosis were the observation range by ultrathin bronchoscopy and the presence/absence of the involved bronchus or pulmonary artery. Pathological evaluation facilitated histological diagnoses in 53 (65.4%) of 81 lesions. In 16 lesions, only the cytological diagnosis was positive. Conclusion CT-guided ultrathin bronchoscopy may be particularly useful for lesions for which the involved bronchus or pulmonary artery can be confirmed, and observation of bronchi of the 6th generation or more is possible. Since the specimen preparation rate is low, the combination of histopathological diagnosis with cytological diagnosis particularly that of the discharge attached to the forceps, is optimal.

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Transbronchial Diagnosis of A Pulmonary Peripheral Small Lesion Using an Ultrathin Bronchoscope with Virtual Bronchoscopic Navigation

Cited by 61 publications

References 7 publications

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

Virtual Bronchoscopic Navigation Improves the Diagnostic Yield of Radial-Endobronchial Ultrasound for Peripheral Pulmonary Lesions with Involved Bronchi on CT

CT-guided Ultrathin Bronchoscopy: Bioptic Approach and Factors in Predicting Diagnosis

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