Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

Abstract

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.

Endobronchial ultrasound plus fluoroscopy-guided biopsy compared to fluoroscopy-guided transbronchial biopsy for obtaining samples of peripheral pulmonary lesions: A systematic review and meta-analysis

“…[2] The combination of EBUS with virtual bronchoscopic navigation has been reported to be between 63.3% and 84.4%. [22] The presence of the bronchus sign on CT, that is, a bronchus containing air adjacent to the PPL, helps guide the bronchoscope to the lesion and increases the diagnostic yield. [23] Another refinement in place of the GS is to measure the distance from the opening of the bronchus to the lesion as a guide for inserting the biopsy forceps.…”

Improvements to bronchoscopic brushing with a manual mapping method: A three‐year experience of 1143 cases

“…Although the mapping method increased sensitivity compared to bronchoscopic brushing alone, other methods can achieve higher sensitivities. For example, virtual bronchoscopy navigation provides better automation and objectivity and can achieve a higher diagnostic yield, from 62.5–84.4%,with a shorter examination time . However, this advanced technology is quite limited in China, and the cost also restricts its routine application.…”

Current advances of endobronchial ultrasonography in the diagnosis and staging of lung cancer

“…The diagnostic yield is similar when ENB or VB is used for biopsy compared with EBUS RP guidance biopsy (16). But when combining two methods such as EBUS RP + ENB, or EBUS RP + VB, the diagnostic yield increases significantly (16,18,(26)(27)(28). Ultrathin bronchoscopy is another tool to increase diagnostic accuracy.…”