Current Novel Advances in Bronchoscopy

Abstract

Screening for lung cancer has changed substantially in the past decade since The National Lung Screening Trial. The resultant increased discovery of incidental pulmonary nodules has led to a growth in the number of lesions requiring tissue diagnosis. Bronchoscopy is one main modality used to sample lesions, but peripheral lesions remain challenging for bronchoscopic biopsy. Alternatives have included transthoracic biopsy or operative biopsy, which are more invasive and have a higher morbidity than bronchoscopy. In hopes of developing less invasive diagnostic techniques, technologies have come to assist the bronchoscopist in reaching the outer edges of the lung. Navigational bronchoscopy is able to virtually map the lung and direct the biopsy needle where the scope cannot reach. Robotic bronchoscopy platforms have been developed to provide stability and smaller optics to drive deeper into the bronchial tree. While these new systems have not yet proven better outcomes, they may reduce the need for invasive procedures and be valuable armamentarium in diagnosing and treating lung nodules, especially in the periphery.

Diagnostic yield of virtual bronchoscope navigation combined with radial endobronchial ultrasound guided transbronchial cryo-biopsy for peripheral pulmonary nodules: a prospective, randomized, controlled trial

“…Combined with the characteristics of the lesions, the radial ultrasonic localization images of PPNs can be divided into the following 3 types: concentric, eccentric, and adjacent (10). VNB is a method for forming a 3D, virtual bronchial tree image, which is generated by importing chest CT data into a special system, and can guide the bronchoscope to the peripheral lung target lesions (14). Gupta et al reported that the diagnostic yield of rEBUS-TBLB for PPN was about 60-70%, but when used in combination with VBN, the diagnostic yield reached 63.3-84% (15).…”

Cập Nhật Vai Trò Nội Soi Phế Quản Chẩn Đoán Và Điều Trị Bệnh Hô Hấp

“…Nội soi phế quản đã phát triển mạnh trong vài thập kỷ qua và được sử dụng rộng rãi trong chẩn đoán và điều trị các bệnh hô hấp. Với sự phát triển của các kỹ thuật nội soi phế quản mới như nội phế quản siêu âm, nội soi phế quản siêu nhỏ, nội soi phế quản có hướng dẫn từ trường… đã mở rộng phạm vi chẩn đoán bệnh phổi [1,2]. Nội soi phế quản can thiệp (nội soi điều trị) đã phát triển nhanh chóng từ những năm 2000.…”

Navigational Bronchoscopy with Interventional Pulmonologists and Thoracic Surgeons

“…We believe a multidisciplinary approach including interventional pulmonologists and thoracic surgeons is crucial to optimize the workup of this group of patients and expedite more invasive diagnostic approaches or therapeutic interventions when needed. -SPiN Perc™ 70-80 12,13 17-21 12,13 Monarch™ 69-77 21,23,24 3.6 23,24 Intuitive Ion™ 79 20,32 0 20,32…”