Bronchoscopic diagnosis of peripheral lung lesions

Gasparini, Stefano; Mei, Federico; Bonifazi, Martina; Zuccatosta, Lina

doi:10.1097/mcp.0000000000000842

Cited by 11 publications

(18 citation statements)

References 28 publications

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“…There has been a rising number of solitary pulmonary nodules (SPNs) being detected due to lung cancer screening initiatives and the growing use of CT. The accurate diagnosis of SPNs, especially peripheral lung nodules, is becoming a challenging task for interventional pulmonologists [ 27 ]. Currently, where multiple innovative technologies are clinically available for the diagnosis of peripheral lung cancer, although promising, the limitation of any single technique should be recognised [ 28 ].…”

Section: Clinical Applicationsmentioning

confidence: 99%

The role of confocal laser endomicroscopy in pulmonary medicine

Tian¹,

Huang²,

Zhang

et al. 2023

Eur Respir Rev

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Accurate diagnosis and subsequent therapeutic options in pulmonary diseases mainly rely on imaging methods and histological assessment. However, imaging examinations are hampered by the limited spatial resolution of images and most procedures that are related to histological assessment are invasive with associated complications. As a result, a high-resolution imaging technology – confocal laser endomicroscopy (CLE), which is at the forefront and enables real-time microscopic visualisation of the morphologies and architectures of tissues or cells – has been developed to resolve the clinical dilemma pertaining to current techniques. The current evidence has shown that CLE has the potential to facilitate advanced diagnostic capabilities, to monitor and to aid the tailored treatment regime for patients with pulmonary diseases, as well as to expand the horizon for unravelling the mechanism and therapeutic targets of pulmonary diseases. In the future, if CLE can be combined with artificial intelligence, early, rapid and accurate diagnosis will be achieved through identifying the images automatically. As promising as this technique may be, further investigations are required before it can enter routine clinical practice.

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Section: Clinical Applicationsmentioning

confidence: 99%

The role of confocal laser endomicroscopy in pulmonary medicine

Tian¹,

Huang²,

Zhang

et al. 2023

Eur Respir Rev

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“…It can be performed with different guidance systems and with different sampling instruments. Over the last decades, in addition to the traditional fluoroscopy, new guidance systems have been developed (radial ultrasound mini probes, electromagnetic navigation bronchoscopy, virtual bronchoscopy, cone beam CT, and robotic bronchoscopy), aiming to improve diagnostic yield, especially for small lesions ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

Suitability of transbronchial needle aspiration for genotyping peripheral pulmonary tumors

et al. 2023

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BackgroundTransbronchial needle aspiration (TBNA) is a sampling tool that has demonstrated a higher accuracy in the diagnosis of peripheral pulmonary lesions (PPL) compared to other techniques. However, there are no studies investigating the value of TBNA in defining the genotype of peripheral lung cancer.ObjectiveTo evaluate the accuracy of TBNA in defining the molecular characteristics of peripheral lung cancer.MethodsConsecutive patients who underwent TBNA for the diagnosis of a PPL at the Pulmonary Unit of the Azienda Ospedali Riuniti of Ancona (Italy) between January 2020 and September 2022 were included in the study. TBNA was performed under fluoroscopic guidance and the additional support of an ultrasound miniprobe, with an ultrathin bronchoscope with a flexible 21G needle. Samples were smeared on glass slides for cytological evaluation and flushed in 10% neutral-buffered formalin for cell-blocks.Results154 patients were enrolled:55 were diagnosed with adenocarcinoma and 21 with squamous cell carcinoma. TBNA correctly diagnosed 43/55 (78.2%) patients with adenocarcinoma and 17/21 (81.0%) patients with squamous cell carcinoma, with a sensitivity of 77.5%. Complete genotyping for guiding targeted therapies was obtained in 52 patients (86.6%).ConclusionsTBNA is a valid tool for the diagnosis of PPL, allowing a correct diagnosis and a complete genotyping of the tumors in a considerable proportion of patients.

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“…The modality of bronchoscopic transbronchial biopsy (TBB) is developing rapidly. Its diagnostic yield is expected to further improve with the combined use of conventional and improved methods (1)(2)(3)(4). An ultrathin bronchoscope (UTB) may also improve the diagnostic yield of TBB by enabling accessibility, bronchial selectivity, and maneuverability in peripheral small bronchi (5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Cone-beam computed tomography-guided endobronchial ultrasound using an ultrathin bronchoscope for diagnosis of peripheral pulmonary lesions: a prospective pilot study

Kawakita¹,

Toba²,

Sakamoto³

et al. 2023

J Thorac Dis

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Background: Multimodal transbronchial biopsy (TBB) may have improved diagnostic yield for peripheral pulmonary lesions suspected as lung cancer. Radial endobronchial ultrasound (R-EBUS) provides real-time imaging and confirmation of the location of the lesions. Cone-beam computed tomography (CBCT) can confirm that the forceps tip has reached the lesion before biopsy.Methods: Patients with peripheral pulmonary lesions and a positive computed tomography (CT) bronchus sign (based on slice thickness of 1 mm) were prospectively enrolled. An ultrathin bronchoscope (UTB) and R-EBUS probe were advanced to the target bronchus. Thereafter, forceps were advanced, and CBCT was performed. R-EBUS was performed for re-navigation, if possible. The obtained EBUS and CBCT images were classified into "within" (type 1), "adjacent to" (type 2), or "far from" (type 3), based on the probe or forceps tip.Results: For 20 lesions, the diagnostic yield was 85%. The primary EBUS images were of types 1, 2, and 3 in 12, 6, and 2 cases, respectively. The primary CBCT images were of types 1, 2, and 3 in 12, 6, and 2 cases, respectively. Primary EBUS and CBCT image types were equivalent in 14 cases. Of the 12 cases with type 1 primary EBUS image, 9 cases had a type 1 primary CBCT image, while 3 cases exhibited positional misalignment of the forceps tip. Re-navigation was required in 8 cases with types 2 and 3 primary CBCT images.Conclusions: CBCT-guided TBB using an UTB and EBUS may enable real-time positioning guidance and better re-navigation in the diagnosis of peripheral pulmonary lesions.

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Bronchoscopic diagnosis of peripheral lung lesions

Cited by 11 publications

References 28 publications

The role of confocal laser endomicroscopy in pulmonary medicine

The role of confocal laser endomicroscopy in pulmonary medicine

Suitability of transbronchial needle aspiration for genotyping peripheral pulmonary tumors

Cone-beam computed tomography-guided endobronchial ultrasound using an ultrathin bronchoscope for diagnosis of peripheral pulmonary lesions: a prospective pilot study

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