Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions

Oki, Masahide; Sasaki, Hideo; Asano, Fumihiro; Kitagawa, Chiyoe; Kogure, Yoshihito; Tsuzuku, Akifumi; Ando, Masahiko

doi:10.1016/j.chest.2019.06.038

Cited by 92 publications

(127 citation statements)

References 37 publications

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“…15 Third, despite the limitations of evaluating efficacy in a pilot study, we feel that the diagnostic yield of 74% achieved in this study with new technology compares favorably with recent publications of established technologies that have largely shown lower diagnostic yields when similarly strict definitions were applied in randomized controlled studies. Although Oki et al 16 reported a diagnostic yield of 70% using ultrathin bronchoscopy, virtual bronchoscopic navigation, and radial ultrasound imaging for pulmonary nodules, a prospective, randomized controlled trial that compared thin bronchoscopy with R-EBUS to conventional transbronchial biopsy with fluoroscopy demonstrated a diagnostic yield of 49% for guided bronchoscopy, which was not statistically different from the yield of conventional bronchoscopy. 2 An additional large prospective observational study that used similar definitions reported a diagnostic yield of 57% among patients who were undergoing various guided bronchoscopic techniques.…”

Section: Discussionmentioning

confidence: 92%

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Chen

Pastis

Mahajan

et al. 2021

Chest

173

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BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield.

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Section: Discussionmentioning

confidence: 92%

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Chen

Pastis

Mahajan

et al. 2021

Chest

173

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“…200 The role of ultrathin bronchoscope was examined in a randomized trial in patients with peripheral pulmonary lesions 30 mm in diameter. 201 The patients were randomized to undergo virtual bronchoscopy, R-EBUS, fluoroscopy-guided bronchoscopy using a 3.0-mm ultrathin bronchoscope or a 4.0mm thin bronchoscope. In the thin bronchoscope group, the use of small forceps with a guide-sheath (GS) or standard forceps without the GS was permitted.…”

Section: Section 6 Diagnostic Methods For Screen-detected Lung Nodulesmentioning

confidence: 99%

“…The procedure duration was significantly shorter in the ultrathin bronchoscope group (median, 24.8 vs. 26.8 min, respectively; P ¼ 0 .008). 201 An earlier meta-analysis of various guided bronchoscopy techniques for biopsy of pulmonary nodules had reported a pooled diagnostic yield of 70% (yield 61% for lesions <2 cm and 82% for lesions >2 cm). 202 The pneumothorax rate was 1.6% with 0.7% for pneumothorax requiring drainage.…”

Section: Section 6 Diagnostic Methods For Screen-detected Lung Nodulesmentioning

confidence: 99%

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Lam

Bryant

Donahoe

et al. 2020

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…It is difficult for the bronchoscopy to reach most nodules, and the diagnostic yield of bronchoscopic-guided lung biopsy ranged from 58 to 70%. 3,4 The diagnostic yield might be even lower if bronchoscopy is applied to nodules less than 10 mm. Performing CT-guided needle biopsy of pulmonary nodules is also often difficult, especially when the nodule is less than 15 mm, or has predominantly ground glass opacity (GGO).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye

Jiang

Lin

Zhao

et al. 2020

Thorac Cardiovasc Surg

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Background This study was aimed to describe a new localization technique developed using medical glue and methylene blue dye, and characterized the localization results and postoperative outcome to evaluate its safety and usefulness. Methods This retrospective study was conducted at our center from January 2016 to April 2018. Totally 346 consecutive patients with 383 nodules who underwent preoperative computed tomography (CT)-guided medical glue and methylene blue dye localization, followed by lung resection, were enrolled in this study. Results Mean nodule size was 7.7 ± 3.7 mm (range: 2–30 mm), with a mean depth from pleura or fissure of 9.4 ± 9.3 mm (range: 0–60 mm). The success rate of CT-guided localization for pulmonary nodules was 99.5% (381/383) of the nodules. Localization-related complications included mild pneumothorax in 16 (4.6%) patients, mild hemothorax in 7 (2.0%) patients, and hemoptysis in 1 (0.3%) patient. Pleural reaction occurred in 7 (2.0%) and pain in 25 (7.2%) patients. All 383 nodules were resected successfully, with conversion to thoracotomy only required in two patients for adhesion and calcification of lymph nodes. All patients recovered well postoperatively, with a short postoperative hospital stay (3.7 ± 2.0 days) and a low complication rate (2.6%, 9/346). Conclusion CT-guided medical glue and methylene blue dye localization prior to video-assisted thoracoscopic surgery (VATS) lung resection was a novel, safe, and technically feasible method, with a high-technical success rate and a low-complication rate. It allowed surgeons to easily locate and detect the nodules and estimate the surgical margin.

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Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions

Cited by 92 publications

References 37 publications

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Robotic Bronchoscopy for Peripheral Pulmonary Lesions

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye

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