Combination of virtual bronchoscopic navigation with conventional transbronchial needle aspiration in the diagnosis of peribronchial pulmonary lesions located in the middle third of the lungs

Matsumura, Yasuo; Kobayashi, Takashi; Hama, Mineyuki; Ichiyama, Takashi; Horiuchi, Toshimichi; Yamamoto, Hiroshi; Kawakami, Satoshi; Hamanaka, Kazutoshi; Honda, Takayuki; Hanaoka, Masayuki

doi:10.1016/j.resinv.2016.04.003

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…Similar to our present study, Hanaoka et al 25 used VBN-assisted C-TBNA in the diagnosis of smaller peribronchial lesions with average size of 11.47 ± 3.4 mm. C-TBNA was used for obtaining the specimens for all the 15 cases.…”

Section: Discussionsupporting

confidence: 88%

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Huang¹,

Huang²,

Ning³

et al. 2019

J. Cancer

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Background: The diagnosis of peribronchial pulmonary lesions located in the tertiary bronchi, also known as segmental bronchi, as well as, the 4th order and 5th order segmental bronchi is very difficult. Histopathological specimens cannot be easily obtained by endobronchial biopsies (EBBX) due to the patent but small segmental bronchial lumen. The aim of the present study was to evaluate the diagnostic accuracy and safety of the novel technique with radial probe endobronchial ultrasound (R-EBUS) assisted conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of solitary peribronchial pulmonary lesions located in segmental bronchi from 3th to 5th order.Methods: From December 2014 to December 2015, 16 patients with solitary peribronchial pulmonary lesions in the segmental bronchi from 3th to 5th order confirmed by computed tomography (CT) were enrolled. The lesions were located using radial probe endobronchial ultrasound (R-EBUS) to determine the sites of conventional transbronchial needle aspiration (C-TBNA), then, histopathological specimens were obtained using the technique of C-TBNA. The final pathological diagnosis was made based on the findings from the surgical specimens. Statistical analyses were performed for specimen results and complications.Results: On pathological evaluation, 14 of the 16 specimens were malignant, including 8 adenocarcinomas, 4 squamous cell carcinomas, and 2 small cell carcinomas, while 2 were non-malignant diseases. The diagnostic accuracy rate, sensitivity and missed diagnosis rates were 87.5%, 87.5% and 12.5%, respectively. When Combined the results of cytology with histologic samples obtained from C-TBNA the total diagnostic accuracy rate, sensitivity and missed diagnosis rate were 93.75%, 93.75% and 6.25%, respectively. There were 2 cases of bleeding complications >5 mL after C-TBNA, and both were resolved with endobronchial management.Conclusions: The combination of R-EBUS with C-TBNA was advantageous and safe for the diagnosis of solitary peribronchial pulmonary lesions located in the segmental bronchi. However, possible bleeding complications should be anticipated with needle aspiration. Further verification of this combined application should be investigated in larger clinical trials.

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Section: Discussionsupporting

confidence: 88%

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Huang¹,

Huang²,

Ning³

et al. 2019

J. Cancer

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“…If the lesion is extrabronchial, we suggest switching to other means of airway exploration that enable taking deeper biopsies, including PPLs located on the outside of the airway wall. Currently used candidate approaches include rEBUS [17, 23] (which allows insertion of larger forceps through the guide-sheath than can be inserted through the working channel of the UTB), VBN-guided fine-needle aspiration [24] (which can obtain blind cytobiopsies after an extrabronchial lesion is located with the VBN system), or transparenchymal nodule access [25, 26] (which could also be used for approaching lesions when segmentation is suboptimal since a straight path could be taken from the end of the segmented airway to the PPL). Although mini-cryobiopsy probes are not commercially available yet, it is thought that they can potentially obtain tissue surrounding distal bronchi [27].…”

Section: Discussionmentioning

confidence: 99%

Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield

et al. 2018

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Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources.

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“…VBN images were constructed from HRCT scans by a navigation system (LungPoint Satellite Planning System, Broncus Technologies Inc., Mountain View, CA, USA) according to a previously described methodology . Prior to examination, the bronchoscopist confirmed the virtual route to the target lesion by VBN.…”

Section: Methodsmentioning

confidence: 99%

“…Instead of X‐ray fluoroscopy, a multi‐detector CT (Aquilion 16; Toshiba, Tokyo, Japan) was used to guide the procedure. The application of VBN was as per previous description and Appendix S1 (Supplementary Information). The position of the target lesion with respect to the tip of the biopsy forceps (FB‐211D, Olympus) was confirmed by the first real‐time multislice CT fluoroscopy (tube voltage: 120 kV; tube current: 10 mA; rotation time: 0.5 s; slice thickness: 2 mm).…”

Section: Methodsmentioning

confidence: 99%

Virtual bronchoscopic navigation as an aid to CT‐guided transbronchial biopsy improves the diagnostic yield for small peripheral pulmonary lesions

et al. 2018

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Combination of virtual bronchoscopic navigation with conventional transbronchial needle aspiration in the diagnosis of peribronchial pulmonary lesions located in the middle third of the lungs

Cited by 10 publications

References 14 publications

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield

Virtual bronchoscopic navigation as an aid to CT‐guided transbronchial biopsy improves the diagnostic yield for small peripheral pulmonary lesions

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