Standard Bronchoscopy With Fluoroscopy vs Thin Bronchoscopy and Radial Endobronchial Ultrasound for Biopsy of Pulmonary Lesions

Tanner, Nichole T.; Yarmus, Lonny; Chen, Alexander; Memoli, Jessica Wang; Mehta, Hiren J.; Pastis, Nicholas J.; Lee, Hans C.; Jantz, Michael A.; Nietert, Paul J.; Silvestri, Gerard A.

doi:10.1016/j.chest.2018.08.1026

Cited by 116 publications

(95 citation statements)

References 11 publications

(19 reference statements)

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“…While not necessarily a study evaluating navigational bronchoscopy, Tanner et al . in their randomized trial comparing conventional bronchoscopy in conjunction with fluoroscopy versus conventional bronchoscopy with fluoroscopic guidance plus rEBUS provided useful information on these bronchoscopic interventions . Disappointingly, they reported a diagnostic yield ranging from 38% to 49%.…”

Section: Discussionmentioning

confidence: 99%

“…The reported sensitivity of CT‐guided biopsy is 90%, but estimates for lesions <1.5 cm are less optimistic (70–82%) . In comparison, the overall diagnostic yield of currently available electromagnetic navigation bronchoscopy (ENB) techniques is lower, approaching 70–73% while other data suggest an even lower rate of 44–57% . When analysed more closely, the diagnostic yield appears to be influenced by nodule size and presence of a bronchus sign …”

Section: Introductionmentioning

confidence: 98%

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Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

et al. 2019

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Background and objective The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is inferior to that of computed tomography (CT)‐guided needle biopsy for pulmonary nodules. One explanation for this is divergence between the nodule location on the pre‐procedure CT scan and its actual location during the procedure. Fluoroscopic ENB (F‐ENB) consists of digital tomosynthesis using a conventional C‐arm to re‐register the target lesion based on near real‐time imaging. We performed a retrospective review of ENB cases at our institution before and after introduction of F‐ENB to assess diagnostic yield. Methods All consecutive ENB procedures performed at our institution from 25 December 2017 to 25 August 2018 were reviewed. F‐ENB was introduced on 25 April 2018. Two cohorts were analysed: standard ENB (S‐ENB) from 25 December 2017 to 24 April 2018 and F‐ENB from 25 April 2018 to 25 August 2018. All procedural, demographic and diagnostic data were collected. Descriptive statistics, chi‐square, Wilcoxon test and Student's t‐test were used where appropriate. A multivariable regression analysis was performed to assess factors associated with diagnostic yield. Results A total of 101 and 67 nodules were biopsied in the S‐ENB and F‐ENB groups, respectively. Diagnostic yield was 54% in S‐ENB cohort and 79% in the F‐ENB group (P = 0.0019). Factors independently associated with a positive diagnosis were F‐ENB and a positive radial ultrasound view (odds ratio (OR): 3.57, 95% CI: 1.56–8.18 and OR: 3.74, 95% CI: 1.37–11.05, respectively). Complications were minimal (pneumothorax: 1.5%). Conclusion The use of F‐ENB may increase the diagnostic yield of ENB and has a low complication rate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

et al. 2019

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“…Recently, a multicenter prospective study compared the diagnostic yield of standard TBB with that of R‐EBUS‐TBB and reported poor diagnostic yield despite combining R‐EBUS with standard TBB. This result may be explained by a high proportion of benign diseases among this study cohort.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer

Lee¹,

Kim

Chang

et al. 2020

Thoracic Cancer

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Background: Although the use of radial endobronchial ultrasound (R-EBUS) with a guide sheath has shown improved diagnostic capability in peripheral pulmonary lesions, its utility is still low due to variable performance. To overcome its limitation, we evaluated the feasibility and efficacy of R-EBUS combined with transbronchial biopsy (TBB) under fluoroscopic guidance. Methods: We retrospectively reviewed medical records of 74 patients with nonsmall cell lung cancer (NSCLC) who underwent R-EBUS combined with TBB or TBB alone as a diagnostic technique. Subjects were grouped according to the diagnostic modality used (R-EBUS combined with TBB vs. TBB alone). Each group was matched for age, sex, and location of the biopsy. The chi-square test and paired t-test were used to compare characteristics and identify factors that affected the diagnostic yield. Results: The mean age of the study cohort was 67.4 AE 12.8 years, with 21 (56.8%) men and 16 (43.2%) women in each group. The lesion size was significantly smaller in the R-EBUS group (23.6 vs. 33.9, P < 0.001). The diagnostic yield with the combined use of R-EBUS and TBB (27/37, 72.9%) was significantly higher than that with standard TBB alone (22/37, 59.4%). Lung lesions with a positive bronchus sign were associated with a higher diagnostic yield (odds ratio = 3.52 [1.17-10.62]; P = 0.025). Conclusions: The combination of R-EBUS with TBB resulted in a higher diagnostic yield than either technique alone. Thus, the addition of R-EBUS biopsy would be helpful to improve the diagnostic yield of TBB. Key points Significant findings of the study: The combination of R-EBUS with TBB under fluoroscopic guidance improved the diagnostic yield of PPLs compared to TBB alone. A tissue diagnosis was more likely in pulmonary lesions with the air-bronchus sign. What this study adds: The use of R-EBUS could help improve the low diagnostic yield of TBB under fluoroscopic guidance without increasing the incidence of complications.

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“…Although the lower complication profile of RP‐EBUS is appealing, its diagnostic yield did not exceed that of transthoracic needle biopsy. While one meta‐analysis reported a pooled diagnostic yield of >70% for RP‐EBUS, several reports showed much lower yields of RP‐EBUS: analysis of the ACCP Quality Improvement Registry, Evaluation, and Education (AQuIRE) registry reported a diagnostic yield of 57% for RP‐EBUS alone, whereas a multicentre prospective trial showed a yield of 49% in a group using thin bronchoscopes and RP‐EBUS …”

Section: Introductionmentioning

confidence: 99%

“…While one meta-analysis reported a pooled diagnostic yield of >70% for RP-EBUS, 8 several reports showed much lower yields of RP-EBUS: analysis of the ACCP Quality Improvement Registry, Evaluation, and Education (AQuIRE) registry reported a diagnostic yield of 57% for RP-EBUS alone, 9 whereas a multicentre prospective trial showed a yield of 49% in a group using thin bronchoscopes and RP-EBUS. 10 EBUS image analysis could be a good supporting technique for tissue sampling from the most suspicious lesion during diagnostic bronchoscopy. When the bronchoscopist encounters suspicious lesions in imaging assessments, the clinician can focus on repeated sampling from the targeted lesion.…”

Section: Introductionmentioning

confidence: 99%

Transbronchial evaluation of peripheral pulmonary lesions using ultrasonic spectrum analysis in lung cancer patients

et al. 2019

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Background and objective Analysis of the endobronchial ultrasound (EBUS) radiofrequency spectrum has been used for convex‐probe EBUS technology. Quantitative imaging analysis is also warranted for guided bronchoscopy using radial‐probe EBUS (RP‐EBUS) targeting peripheral pulmonary lesions (PPL). This study aimed to determine the feasibility of radiofrequency spectrum analysis for distinguishing malignant and benign PPL during diagnostic bronchoscopy. Methods Raw RP‐EBUS images with radiofrequency data, including backscatter signals, were prospectively recorded. The ultrasonic spectral parameters, such as intercept, midband‐fit and slope within the region of interest, were retrospectively computed by linear regression analysis and compared with the final diagnosis. Results A total of 71 PPL, including 45 malignant and 26 benign lesions, were analysed. Malignant PPL showed a significantly lower intercept (P < 0.0001), lower midband‐fit (P < 0.0001) and higher slope (P = 0.014) than benign PPL. Analyses of the area under the curve of receiver operating characteristic plots demonstrated that the intercept showed the best diagnostic performance among three parameters (0.87, 0.77 and 0.69 for intercept, midband‐fit and slope, respectively). The sensitivity, specificity, accuracy, positive likelihood and negative likelihood were 75.6%, 96.2%, 83.1%, 19.6 and 0.25 for the intercept; 88.9%, 57.7%, 77.5%, 2.1 and 0.19 for the midband‐fit; and 68.9%, 73.1%, 70.4%, 2.6 and 0.43 for the slope. Conclusion Spectrum analysis of EBUS radiofrequency can be used as a novel non‐invasive predictor of malignant or benign PPL. Analysis of the ‘intercept’ of the targeted lesion may provide useful supporting data for real‐time sampling from PPL during diagnostic bronchoscopy.

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Standard Bronchoscopy With Fluoroscopy vs Thin Bronchoscopy and Radial Endobronchial Ultrasound for Biopsy of Pulmonary Lesions

Abstract: Bronchoscopy with or without a thin scope and R-EBUS had a poor diagnostic yield for pulmonary lesions. Future work should focus on improvements in technique and technology advances that ensure a higher likelihood of obtaining a diagnosis.

Cited by 116 publications

References 11 publications

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer

Transbronchial evaluation of peripheral pulmonary lesions using ultrasonic spectrum analysis in lung cancer patients

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