Bronchoscopy for Pulmonary Peripheral Lesions With Virtual Fluoroscopic Preprocedural Planning Combined With EBUS-GS

Fukusumi, Munehisa; Ichinose, Yoshiaki; Arimoto, Yoshihito; Takeoka, Shinji; Homma, Chie; Matsuoka, Hiroyasu; Mouri, Atsuto; Hamamoto, Yoichiro; Matsumoto, Junichi; Kamimura, Mitsuhiro

doi:10.1097/lbr.0000000000000273

Cited by 15 publications

(11 citation statements)

References 9 publications

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“…The studies on TBLB-rEBUS&VBN and the studies on CT-TNB were analyzed separately. The former included 9 papers with a total of 813 procedures [ 13 , 21 – 28 ]. All these studies were conducted in Japan between 2005 and 2016.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

et al. 2018

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BackgroundAdvances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis.We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs.MethodsA systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter.ResultsFrom 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) using the BR approach and 93% (95% CI, 90–96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88–95) was superior to the BR approach (66%, 95% CI: 55–76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach.ConclusionsCT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.

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Section: Resultsmentioning

confidence: 99%

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

et al. 2018

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“…In addition, virtual fluoroscopy constructed with virtual bronchoscopy facilitates confirmation of the location of the GGN even if the GGN cannot be detected on chest X-rays or by real-time fluoroscopy. [ 18 ] In such cases, using this technique, we can move the bronchoscope as close as possible to the target lesion through the preplanned bronchial route generated by the virtual bronchoscopy and select the biopsy site based on virtual fluoroscopy guidance and EBUS images. The use of virtual bronchoscopy and virtual fluoroscopy would resolve the problems (e.g., complicated access routes to the target and poor visibility in fluoroscopy) that make transbronchial diagnosis for GGNs difficult.…”

Section: Discussionmentioning

confidence: 99%

“…When the target GGN could not be detected on the chest X-ray or through real-time X-ray fluoroscopy, we utilized virtual fluoroscopy as a reference for forceps guidance. [ 18 ] If the EBUS image could not be visualized, as in cases of solid lesions, we manipulated the probe under fluoroscopic guidance until a whitish acoustic shadow, which we previously reported as blizzard sign or mixed blizzard sign, was generated. [ 12 ] When evaluating the location of the probe against the GGN, EBUS images were divided into three groups according to a previously published report:[ 19 ] “within” (the probe was located in the bronchus inside the GGN), “adjacent to” (the probe was located in the bronchus alongside the GGN), or “invisible” (the probe was located in the bronchus, but the GGN could not be seen).…”

Section: Methodsmentioning

confidence: 99%

Predictive factors for a successful diagnostic bronchoscopy of ground-glass nodules

et al. 2017

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INTRODUCTION:Since the National Lung Screening Trial demonstrated the utility of low-dose computed tomography screening for lung cancer, the detection rate of ground-glass nodules (GGNs) has increased. Endobronchial ultrasound with a guide sheath (EBUS-GS) is widely performed to diagnose peripheral pulmonary lesions, but there are not enough reports on the predictive ability of EBUS-GS in diagnosing GGNs. The aim of this study is to investigate the predictive factors for a successful diagnostic bronchoscopy for GGNs.METHODS:Consecutive patients who underwent diagnostic bronchoscopy for GGNs from September 2012 to January 2016 were enrolled in this study. From these, cases who underwent EBUS-GS were selected. They were reviewed and analyzed to examine the association between the diagnostic yield and the following clinical factors: lesion size, lobar position, location, consolidation-to-tumor ratio, visibility on X-ray, use of virtual bronchoscopy, bronchus sign, guide sheath size, and number of biopsies.RESULTS:We enrolled 254 cases, of which 167 were diagnosed using EBUS-GS (65.7% diagnostic yield). Univariate analysis indicated that a positive bronchus sign was a significant factor for higher diagnostic yield (72.9% vs. 34.0%; P < 0.001). The use of virtual bronchoscopy also tended toward a higher yield, but the result was not significant (69.0% vs. 54.4%; P = 0.058). However, multivariate analysis indicated that both were significantly associated with higher diagnostic yield (P < 0.001, odds ratio [OR]: 5.35; P < 0.001, OR: 1.97, respectively).CONCLUSIONS:Our results suggest that a positive bronchus sign and the use of virtual bronchoscopy are positive predictive factors for successful diagnostic bronchoscopy of GGNs.

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“…VF imaging can thus be used as a reference for biopsy sites during bronchoscopy regardless of the visibility on GGNs on real-time X-ray fluoroscopy. The use of VF for bronchoscopy has been previously described (16), and unlike other guiding techniques, VF images can be easily and quickly constructed from multi-slice CT volume data and workstations without additional cost. The present study evaluated the diagnostic utility of VF in addition to EBUS-GS with VB for GGNs that were not visible on X-ray fluoroscopy.…”

Section: Original Article Of Interventional Pulmonology Cornermentioning

confidence: 99%

“…The VB was constructed using a previously reported method (23). VF images were then constructed from the volume data obtained from multidetector CT imaging using the Ziostation2 ® ; the target lesion was extracted, and a trace line was drawn to create a VB from the trachea to the target lesion along the connecting bronchus on a ray summation image similar to X-ray fluoroscopy (16).…”

Section: Vfmentioning

confidence: 99%

Virtual fluoroscopy during transbronchial biopsy for locating ground-glass nodules not visible on X-ray fluoroscopy

Nakai¹,

Izumo²,

Tsuchida³

2017

J. Thorac. Dis.

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Background: Virtual fluoroscopy (VF) is a novel guided technique that provides ray summation images of target lesions similar to X-ray fluoroscopy. Endobronchial ultrasound with a guide sheath (EBUS-GS) is a useful modality for imaging ground-glass nodules (GGNs) but is not ideal for GGNs that cannot be detected on X-ray fluoroscopy. We evaluated whether the addition of VF to EBUS-GS improved the diagnostic yield.Methods: Consecutive patients who had undergone diagnostic bronchoscopy for GGNs that were not detected on X-ray fluoroscopy between September 2012 and January 2016 were retrospectively enrolled.The patients were divided into two groups: a non-VF group [performed using conventional thin-section computed tomography (CT), X-ray fluoroscopy, EBUS-GS, and virtual bronchoscopy for reference], and a VF group (performed using additional VF to non-VF group). We then compared the diagnostic yields between the two groups and performed a multivariate analysis to identify factors associated with an increased diagnostic yield.Results: A total of 74 patients (VF, 35 patients; non-VF, 39 patients) were enrolled and were included in the analysis. The diagnostic yield was significantly higher in the VF group (77.1%) than in the non-VF group (51.2%, P=0.030). There were no clinically significant complications in either group. In the multivariate analysis, a positive bronchus sign [odds ratio (ORs), 5.41; 95% confidence interval (CI), 1.36-21.40] and the use of VF (odds ratio, 3.68; 95% confidence interval, 1.16-11.60) were significantly associated with successful bronchoscopic diagnosis.Conclusions: The addition of VF to EBUS-GS helped to identify GGNs that were not visible on X-ray fluoroscopy.Keywords: Lung cancer; ground-glass nodule (GGN); bronchoscopy; virtual fluoroscopy (VF); virtual bronchoscopy (VB); radial endobronchial ultrasound with a guide sheath (EBUS-GS)

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Bronchoscopy for Pulmonary Peripheral Lesions With Virtual Fluoroscopic Preprocedural Planning Combined With EBUS-GS

Abstract: VFPP was easy to prepare and useful for selecting target bronchi. This study confirms feasibility of the VFPP as an adjunct to minimally invasive transbronchial biopsy of pulmonary peripheral lesions.

Cited by 15 publications

References 9 publications

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

Predictive factors for a successful diagnostic bronchoscopy of ground-glass nodules

Virtual fluoroscopy during transbronchial biopsy for locating ground-glass nodules not visible on X-ray fluoroscopy

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