Virtual bronchoscopic navigation without fluoroscopy guidance for peripheral pulmonary lesions in inexperienced pulmonologist

Abstract

Objective Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath (EBUS-GS) in peripheral pulmonary lesions (PPLs). Virtual bronchoscopic navigation (VBN) can guide the bronchoscope by creating virtual images of the bronchial route to the lesion. The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS. Methods Between January 2016 and June 2017, consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled. The diagnostic yield as well as safety profiles was retrospectively analyzed, and our preliminary experience was shared. Results A total of 109 patients with 109 lesions were included, 99 (90.8%) lesions were visible on EBUS imaging. According to the procedure time needed to locate the lesion on EBUS, 24.8% (27/109) were deemed technically difficult procedures; however, no significant relationships were identified between candidate parameters and technically difficult procedures. The overall diagnosis yield was 74.3% (81/109), and the diagnostic yield of malignancy was 83.7% (77/92). Lesions larger than 20 mm [odds ratio (OR), 2.758; 95% confidence interval (95% CI), 1.077−7.062; P=0.034] and probe of within type (OR, 3.174; 95% CI, 1.151−8.757, P=0.026) were independent factors leading to a better diagnostic yield in multivariate analysis. About 30 practice procedures were needed to achieve a stable diagnostic yield, and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures. Regarding complications, one patient (0.9%) had intraoperative hemorrhage (100 mL) which was managed under endoscopy. Conclusions VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis, especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS. VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.

Virtual bronchoscopic navigation and endobronchial ultrasound with a guide sheath without fluoroscopy for diagnosing peripheral pulmonary lesions with a bronchus leading to or adjacent to the lesion: A randomized non‐inferiority trial

“…In subgroup analysis with PPLs ≤30 mm, the results were also confirmed. These results were comparable or superior to those from previous studies of VBN‐rEBUS‐GS without fluoroscopy 14–16 . This could be related to the present study including substantial proportions of relatively large lesions (>30 mm, 53.3%), within two‐third from hilum (66.9%) and malignant lesions (80.8%) 6,7,24 .…”

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

“…Yoshikawa et al have reported that EBUS‐GS‐guided bronchoscopy without fluoroscopy is an effective method for diagnosing PPLs using conventional videobronchoscopy 11 . In addition, recent reports have shown that use of a 4.0‐mm outer diameter thin bronchoscope combined with VBN and EBUS‐GS is a feasible option for the diagnosis of PPLs 12,13 . Another preliminary randomized controlled trial evaluated the diagnostic value of VBN‐EBUS‐GS with or without X‐ray fluoroscopy in 31 patients with PPLs of ≤30 mm, with comparable diagnostic yields between the X‐ray and non‐X‐ray groups, especially for malignant lesions 14…”

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

“…VBN is regarded as a relatively more economical and less harmful guidance method and is even equally effective with fluoroscopic guidance in diagnosing PPNs. 10 , 11 However, in a few cases, the nodule could not be visualized by rEBUS, even if those techniques were used in combination. If transbronchial biopsy is performed on these rEBUS-invisible nodules, it will present a particular problem that it becomes a “blind” biopsy.…”