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

Zheng, Xiaoxuan; Xie, Fangfang; Liu, Ying; Chen, Junxiang; Jiang, Yifeng; Sun, Jiayuan

doi:10.1111/1759-7714.13995

Cited by 19 publications

(47 citation statements)

References 32 publications

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“…Following abstract review, 32 articles were selected for full-text review. Of these, 15 articles were excluded according to the protocol, and two studies missed in the database search were added [ 22 , 23 ]. Therefore, 19 studies formed the basis of our systematic review [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…Finally, our study was not registered prior to the review, but we followed the suggested PRIS-MA protocol. Asano 2013 [30] Oki 2015 [31] Diez-Ferrer 2019 [35] Oki 2019 [13] Sumi 2020 [37] Sumi 2021 [39] Zheng 2021 [23] Total (95% Cl) Heterogeneity: τ 2 = 0.0272; χ 2 = 20.09, df = 7 (p < 0.01); I 2 = 65% Test for overall effect: Z = -2. 29 Oki 2009 [28] Oki 2015 [31] Oki 2019 [13] Sumi 2020 [37] Sumi 2021 [39] Zheng 2021 [23] Total (95% Cl)…”

Section: Discussionmentioning

confidence: 99%

“…The recent development of 1.7 mm channel size allows the passage of r-EBUS [28], which provides a 360° view of the surrounding lesion by the ultrasound transducer [43] and shows a pooled diagnostic yield of 0.73 (95% CI, 0.70-0.76) [40]. The r-EBUS probe position relative to the lesion was known to be associated with the diagnostic yield of TBB, where the diagnostic yield of within, adjacent to, and outside the lesion was Shinagawa 2004 [24] Yamamoto 2004 [25] Shinagawa 2007 [26] Tachihara 2007 [27] Oki 2009 [28] Matsuno 2011 [22] Oki 2012 [29] Asano 2013 [30] Oki 2015 [31] Franzen 2016 [32] Tokoro 2016 [33] Ali 2019 [34] Diez-Ferrer 2019 [35] Oki 2019 [13] Sehgal 2019 [36] Sumi 2020 [37] Kawakita 2021 [38] Sumi 2021 [39] Zheng 2021 [23] Total (95% CI) 0.83, 0.61, and 0.04, respectively (p < 0.001) [44]. In line with this, Nishi et al [45] reported that UTB showed improved r-EBUS probe position for PPL after substituting thin bronchoscope (adjacent, 12; not visible, 32) by UTB (within, 26; adjacent, 11; not visible, 7) combined with fluoroscopy and VBN.…”

Section: Discussionmentioning

confidence: 99%

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Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Kim

Pak

et al. 2022

Respiration

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Background: Ultrathin bronchoscopy (external diameter, ≤3.5 mm) is useful for the diagnosis of peripheral pulmonary lesions because of its good accessibility. Objectives: We performed a meta-analysis to investigate the diagnostic yield of ultrathin bronchoscopy for peripheral pulmonary lesions. Methods: We performed a systematic search of MEDLINE and EMBASE (from inception to May 2021), and meta-analysis was performed using R software. The diagnostic yield was evaluated by dividing the number of successful diagnoses by the total number of lesions, and subgroup analysis was performed to identify related factors. Results: Nineteen studies with a total of 1,977 peripheral pulmonary lesions were included. The pooled diagnostic yield of ultrathin bronchoscopy was 0.65 (95% confidence interval, 0.60–0.70). Significant heterogeneity was observed among studies (χ2, 87.75; p < 0.01; I2, 79.5%). In a subgroup analysis, ultrathin bronchoscopy with 1.2 mm channel size showed a diagnostic yield of 0.61 (95% confidence interval, 0.53–0.68), whereas ultrathin bronchoscopy with 1.7 mm channel size showed 0.70 (95% confidence interval, 0.66–0.74) (χ2, 5.35; p = 0.02). In addition, there was a significant difference in diagnostic yield based on lesion size, histologic diagnosis (malignant vs. benign), bronchus sign, and lesion location from the hilum, whereas no significant difference was found based on lobar location. The overall complication rate of ultrathin bronchoscopy was 2.7% (pneumothorax, 1.1%). Conclusions: Ultrathin bronchoscopy is an excellent tool for peripheral pulmonary lesion diagnosis with a low complication rate. The diagnostic yield of ultrathin bronchoscopy was significantly higher with larger channel size, which might be attributed to the availability of radial endobronchial ultrasound.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Kim

Pak

et al. 2022

Respiration

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“…Alguns estudos mostraram que o desempenho diagnóstico da CBTB nas LPP é igualmente bom com ou sem fluoroscopia. (19,20) Portanto, é razoável supor que é possível realizar a criobiópsia sem o auxílio da fluoroscopia. Neste estudo, demonstramos a utilidade da CBTB guiada por EBUS radial com bainha guia sem fluoroscopia na avaliação de LPP.…”

Section: Discussionunclassified

Diagnostic performance of cryobiopsy guided by radial-probe EBUS with a guide sheath for peripheral pulmonary lesions

Chen1

Yon

et al. 2022

J Bras Pneumol.

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Objective: Transbronchial lung cryobiopsy (TBCB) has developed rapidly and has become one of the research hotspots of lung biopsy technology. The present study sought to evaluate the efficacy of TBCB guided by radial-probe EBUS (RP-EBUS) and a guide sheath (GS) without fluoroscopy for peripheral pulmonary lesions. Methods: In this retrospective study, McNemar's test was used in order to compare TBCB and transbronchial forceps biopsy (TBFB) in terms of diagnostic performance. A multivariate logistic regression model was designed to explore the association between predictive variables and the diagnostic yield of TBCB. Results: A total of 168 patients underwent GS-guided RP-EBUS. Of those, 157 had lesions that were visible and 11 had lesions that were not. Of those 157 patients, 24 were excluded because of missing data or an unclear final diagnosis. Therefore, 133 patients underwent RP-EBUS-GS-guided TBFB and TBCB. The pooled diagnostic yield of RP-EBUS-GS-guided TBCB without fluoroscopy was 71.5% (103/144). In 133 patients, the diagnostic yield of TBCB was significantly higher than that of TBFB (77.4% vs. 59.4%; p < 0.05). Multivariate analysis indicated that lesion size and site were independently associated with the diagnostic yield of TBCB (OR = 2.8, p = 0.03 and OR = 4.1, p = 0.01, respectively), although cryoprobe size was not. There was no significant difference between the 1.1-mm cryoprobe and the 1.9-mm cryoprobe in terms of diagnostic performance (78.4% vs. 76.8%; p > 0.05). Conclusions: GS-guided RP-EBUS is regarded as a practical option for guiding cryobiopsy, although it may not be able to replace fluoroscopy. Peripheral pulmonary lesions not located in the upper lobes or larger than 30 mm are significantly associated with a higher diagnostic yield of cryobiopsy.

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“…Therefore, it is reasonable to recommend the bronchoscopic sample collection of these nodules under VBN-rEBUS guidance, which is feasible and safe. 16 , 17 For another part of nodules with the S/D ratio less than 1.84 may not be visualized by rEBUS, which may have a poor diagnostic yield by bronchoscopic biopsy. Even with the assistance of fluoroscopy, the diagnostic yield of those nodules may still be limited.…”

Section: Discussionmentioning

confidence: 99%

An Innovative Method: Predicting the Visibility of Radial Endobronchial Ultrasound for Peripheral Pulmonary Nodules by Virtual Bronchoscopic Navigation

Chen

et al. 2022

Technol Cancer Res Treat

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Background: The diagnosis of peripheral pulmonary nodules (PPNs) still is the key and difficult point. Previous studies have demonstrated that the diagnostic yield of radial endobronchial ultrasound (rEBUS) visible nodules is significantly higher than that of invisible nodules. The traditional method of predicting the rEBUS-visibility of nodules is based on the CT-bronchus signs, but its effectiveness may be unsatisfactory. Objective: We innovate a valuable predictive model based on virtual bronchoscopic navigation to identify beforehand which PPNs are likely to be successfully visualized by rEBUS. The innovative predictor is the ratio of the size of lesions (S) to the shortest straight-line distance (D) from the terminal point of the virtual navigation path to the localization point of the nodule. Methods: This is a retrospective study. On the training dataset of 214 patients, a receiver operating characteristic curve was drawn to understand the utility of the predictive model and get the optimal cut-off points. Ninety-two cases were enrolled in the validation dataset to validate the external predictive accuracy of the predictor. Results: The optimal cut-off point of the curve was 1.84 with the Youden index of 0.65, at which point the area under the curve was 0.85 (95% CI: 0.76-0.95). The predictor has a good performance in the validation dataset with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81%, 100%, 100%, 71%, and 87%, respectively. Conclusion: The S/D ratio is a valuable and innovative method to identify beforehand which PPNs are likely to be successfully visualized by rEBUS. If the S/D ratio of the nodule is greater than 1.84, it will be visualized by rEBUS.

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

Cited by 19 publications

References 32 publications

Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Diagnostic performance of cryobiopsy guided by radial-probe EBUS with a guide sheath for peripheral pulmonary lesions

An Innovative Method: Predicting the Visibility of Radial Endobronchial Ultrasound for Peripheral Pulmonary Nodules by Virtual Bronchoscopic Navigation

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