Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions

Abstract

Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs.

Assessment of using radial probe endobronchial ultrasound with a guide sheath to increase the yield rate of transbronchial biopsy: A prospective randomized trial

“…However, uoroscopy can serve the same purpose and increase the accuracy and diagnostic yield. (35,36) While, as previously described, GS had better performance in small lesions, Ito et al (17) suggested that when under uoroscope-guidance, the conventional method could have even better performance.…”

Using cryoprobes of different sizes combined with cone-beam computed tomography-derived augmented fluoroscopy and endobronchial ultrasound to diagnose peripheral pulmonary lesions: a propensity-matched study

“…Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) is a technique that provides real-time 2-dimensional (2D) fluoroscopy and 3-dimensional (3D) CBCT scans, and has also been used in bronchoscopy procedures [ 4 – 7 ]. CBCT-AF can guide navigation for the bronchial route, and confirm the location of target PPLs, thereby improving diagnostic accuracy during EBUS-TBB [ 8 , 9 ]. Traditionally, most TBB procedures employed standard biopsy forceps, which frequently obtained small, crushed tissue samples that could affect molecular analysis for further cancer management [ 10 – 12 ].…”

Cone-Beam Computed-Tomography-Derived Augmented Fluoroscopy-Guided Biopsy for Peripheral Pulmonary Nodules in a Hybrid Operating Room: A Case Series

“…The advent of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration has made it possible to perform a guided biopsy of small PPNs and lesions located near the airways [ 10 ]. However, the diagnostic yield of EBUS for extremely small PPNs is relatively unsatisfactory [ 11 ]. Tools such as a thin bronchoscope and guide sheath or techniques such as fluoroscopy or virtual bronchoscopy navigation have been developed to assist EBUS-guided biopsy in increasing diagnostic yield.…”

“…Tools such as a thin bronchoscope and guide sheath or techniques such as fluoroscopy or virtual bronchoscopy navigation have been developed to assist EBUS-guided biopsy in increasing diagnostic yield. Nevertheless, some limitations still demonstrate the necessity for more effective systems [ 11 ].…”

“…However, in these procedures, CBCT was not applied as a confirmation technique, considered the gold standard for checking the probe location. EBUS performed with AFB and CBCT is an advanced technique that is more efficient in reaching the target, with a higher diagnostic yield [ 11 ]. AFB with CBCT has advantages for interventional pulmonologists in complicated cases involving PPN.…”