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

Asano, Fumihiro; Shinagawa, Naofumi; Ishida, Takashi; Tsuzuku, Akifumi; Tachihara, Motoko; Kanazawa, Kenya; Yamada, Noriyuki; Oizumi, Satoshi; Moriya, Hideshige

doi:10.2169/internalmedicine.54.3497

Cited by 35 publications

(39 citation statements)

References 18 publications

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“…CT bronchus sign positivity is significantly associated with visualization of the lesion using EBUS and a successful bronchoscopic diagnosis using EBUS-GS (19)(20)(21). In the present study CT bronchus sign positivity was found to be significantly associated with a successful diagnosis and with EBUS visualization in both the univariate and multivariate analyses.…”

Section: Discussionsupporting

confidence: 58%

“…Ishida et al reported that VBN improved the diagnostic yield while decreasing the overall duration of the examina-tion (25). In a recent study, Asano et al revealed that VBN improved the diagnostic yield for lesions showing involved bronchi on CT images (21). In the present study, all patients underwent bronchoscopy with VBN and CT bronchus sign positivity was independently associated with a successful diagnosis.…”

Section: Discussionsupporting

confidence: 54%

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Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

et al. 2016

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Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (! 30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT bronchus sign positivity, a solid nodule, and a probe position that was within the lesion.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionsupporting

confidence: 54%

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

et al. 2016

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“…Furthermore, multiple studies have demonstrated that VB may improve diagnostic performance of radial EBUS [10,30,31]. In centres where these adjunct tools are not utilised, the incremental gain in diagnostic performance with addition of EMN may be greater than observed in our current study.…”

Section: Discussionmentioning

confidence: 45%

“…However, consumable costs for EMN are significant and reducing utilisation of these consumables will reduce overall healthcare costs. Isolated reports suggest combining the two techniques may achieve the highest diagnostic yields [7], although given EBUS achieves a sensitivity of 73% [2], and exceeding 84% in some reports [8][9][10], the cumulative gain seen following addition of EMN may not justify routine use of EMN consumables. Only one study has reported use of EMN only if peripheral lesions were unable to be localised with EBUS [11].…”

Section: Introductionmentioning

confidence: 99%

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±SD). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield. @ERSpublications EMN after nondiagnostic radial EBUS gives only small incremental gain in visualisation rate and diagnostic yield

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“…Many previous studies (5,7,(14)(15)(16) also suggested that bronchus sign or the probe located in the center of the lesion were positive factors for a higher diagnostic yields of EBUS-GS. Besides, the application of virtual bronchoscope and electromagnetic navigation bronchoscope could assist the probe to reach the target lesion and improve diagnostic accuracy (23)(24)(25). The complication rate of EBUS-GS was 2%, which was not significantly lower than CT-TTNA (13%) in this study.…”

Section: Discussionmentioning

confidence: 53%

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

et al. 2016

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Background: Computed tomography guided transthoracic needle aspiration (CT-TTNA) and endobronchial ultrasonography with guide sheath (EBUS-GS) transbronchial lung biopsy are important methods for the diagnosis of peripheral pulmonary lesions (PPLs). Without enough evidence, it is controversial which is a better choice for diagnosing PPLs. In this study, we hypothesized that the complication rate of EBUS-GS would be lower than CT-TTNA and the diagnostic accuracy of EBUS-GS were not inferior to CT-TTNA. Methods: This study was a retrospective analysis of a prospective registry with propensity matching.Patients with PPLs were divided into EBUS-GS group and CT-TTNA group according to patients' intent to treatment. Pathological results and procedure related complications of EBUS-GS and CT-TTNA were recorded. Propensity score matching(PSM) was used to eliminate the intergroup bias. Diagnostic yields and complications of two groups were compared. Subgroup analysis was performed to conclude the indications of different procedures. Results: A total of 187 patients (CT-TTNA: 130; EBUS-GS: 57) were enrolled. After propensity score matching, 54 paired patients were included. Diagnostic yield was 81% (44/54) for EBUS-GS and 87% (47/54) for CT-TTNA (P=0.43), respectively. Diagnostic sensitivity in malignancy was 93% (42/45) for CT-TTNA and 79% (37/47) for EUBS-GS (P=0.04). Subgroup analysis revealed that the sensitivity of CT-TTNA was significantly higher in diagnosing of lesions close to the chest wall (100% vs. 80%, P=0.04), and bronchus sign on CT was a predictive factor for accurate diagnosis by EBUS-GS. The overall complication rate was 13% (7/54) for CT-TTNA group, which was not significantly higher than that of EBUS-GS group (2%, P=0.06). Subgroup analysis showed that patients combined with pulmonary comorbidities and lesions apart from chest wall were risk factors for complications of CT-TTNA. Conclusions: Both of the two procedures are effective for the diagnosis of PPLs, but CT-TTNA has a higher diagnostic sensitivity for malignancy. EBUS-GS has fewer complications, and it is more suitable for patients combined with pulmonary comorbidities and lesions with bronchus signs.

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

Cited by 35 publications

References 18 publications

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis

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