Diagnostic yield and safety of navigation bronchoscopy: A systematic review and meta-analysis

Kops, Stephan E. P.; Heus, Pauline; Korevaar, Daniël A.; Damen, Johanna Aag; Idema, Demy L.; Verhoeven, Roel L.J.; Annema, Jouke T.; Hooft, Lotty; Heijden, Erik H.F.M. van der

doi:10.1016/j.lungcan.2023.107196

Cited by 25 publications

(20 citation statements)

References 105 publications

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“…The pooled diagnostic yield in our meta‐analysis is comparable to previously published studies that reported pooled diagnostic yields of 76.5%–84.3% for RAB 11,14,41 . Despite the comparable results, in previous meta‐analyses, the diagnostic yields in the included studies were defined differently.…”

Section: Discussionsupporting

confidence: 73%

“…First, to unify the definition of diagnostic yield, we had to exclude the studies that did not report sufficient data to calculate the diagnostic yield according to our definition. The problems associated with heterogeneous and incomplete outcomes reported by diagnostic accuracy studies were also mentioned in prior meta‐analyses 41,48 . Establishment of a standardized definition of the diagnostic outcomes and adherence to reporting guidelines for diagnostic accuracy studies (e.g., STARD 2015) may alleviate this phenomenon 49 .…”

Section: Discussionmentioning

confidence: 99%

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Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Zhang,

Xie,

et al. 2024

Thoracic Cancer

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Robotic‐assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta‐analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta‐analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high‐quality prospective studies still need to be conducted.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Zhang,

Xie,

et al. 2024

Thoracic Cancer

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“…1,2 New innovations, such as robotassisted bronchoscopy, have not closed this gap to date. 3,4 This difference can be explained by various factors. The PNs that are targeted are small and move with breathing, and millimeter changes of instrument positioning can make the difference between sampling the target or missing it.…”

Section: Introductionmentioning

confidence: 99%

“…Despite these advances, an approximate 15% difference remains between accurately reaching the lesion and obtaining a diagnosis 1,2 . New innovations, such as robot‐assisted bronchoscopy, have not closed this gap to date 3,4 . This difference can be explained by various factors.…”

Section: Introductionmentioning

confidence: 99%

Rapid on‐site evaluation of touch imprint cytology in navigation bronchoscopy for small peripheral pulmonary nodules

Kops,

van der Burgt,

Vos

et al. 2024

Cancer Cytopathology

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BackgroundRapid on‐site evaluation (ROSE) of cytopathology plays an important role in determining whether representative samples have been taken during navigation bronchoscopy. With touch imprint cytology (TIC), histologic samples can be assessed using ROSE. Although advised by guidelines, there have been almost no studies on the performance of TIC during navigation bronchoscopy. The objective of this study was to evaluate the value of TIC‐ROSE (forceps/cryobiopsy) in combination with conventional ROSE (cytology needle/brush).MethodsIn this single‐center, prospective cohort study, patients who had pulmonary nodules with an indication for navigation bronchoscopy were consecutively included. The primary outcome of the study was the concordance of ROSE and the procedural outcome. The concordance rates of TIC‐ROSE and the combination of TIC‐ROSE plus conventional ROSE were compared.ResultsFifty‐eight patients with 66 nodules were included. Conventional ROSE and TIC‐ROSE were assessable in 61 nodules (90.9%) each. By combining both ROSE techniques, all sampled lesions were assessable. Combining conventional ROSE with TIC‐ROSE showed concordant results in 51 of 66 cases (77.3%) versus 44 of 66 (66.7%) and 48 of 66 (72.8%) concordant results for conventional ROSE and TIC‐ROSE alone, respectively, compared with the procedural outcome. There was no indication of tissue depletion as a result of TIC. The combined ROSE approach had a statistically significant higher concordance rate compared with conventional ROSE alone.ConclusionsTIC‐ROSE is a cheap, easily implementable technique that can result in higher concordant ROSE outcomes. This could lead to more efficient procedures and possibly higher diagnostic results. In a monomodality sampling setting with only histologic samples, TIC can provide ROSE.

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“…The improvement of endoscopic modalities to biopsy PPL began in the early 2000s with the development of radial EBUS (R-EBUS) [7]. Since then, numerous technical improvements that augment the ability to guide the bronchoscope to a PPL, confirm the location of the PPL, and provide representative samples of the PPL have been added to improve the diagnostic yield of endoscopic techniques while maintaining low complication rates (2-5% of risk of pneumothorax) [8][9][10]. These novel endoscopic techniques, which may be combined, include ultra-thin bronchoscopy, virtual navigation, electromagnetic navigation (EMN), conebeam computed tomography-guided bronchoscopy (CBCT), and robotic bronchoscopy [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

An International Survey of Practices in the Investigation and Endoscopic Treatment of Peripheral Pulmonary Lesions amongst Interventional Bronchoscopists

Soumagne,

Dutau,

Eapen

et al. 2024

Respiration

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Introduction: The investigation of peripheral pulmonary lesions (PPLs) can be challenging. Several bronchoscopic modalities have been developed to reach and biopsy PPL but the level of adoption of these techniques by interventional pulmonologists (IPs) is unknown. This international survey was conducted to describe current practices in PPL investigation among IP. Methods: This survey was sent to all members of the World Association for Bronchology and Interventional Pulmonology, Canadian Thoracic Society Procedures Assembly, AABIP, and the Groupe d’Endoscopie Thoracique et Interventionnel Francophone. The survey was composed of 48 questions and three clinical cases to establish a portrait of modalities used to investigate and treat PPL by IP around the world. Results: Three hundred and twelve IP responded to the survey. Most of them practice in Europe (n = 122), North America (n = 97), and Asia (n = 49). Half of responders perform more than 100 endoscopic procedures for PPL annually. General anesthesia and conscious sedation are used in similar proportions (53% and 47%, respectively). Rapid on site evaluation (ROSE) is used when sampling PPL by 42%. Radial EBUS (69%), fluoroscopy (55%), and electromagnetic navigation (27%) are the most widely used techniques. Most IP combine techniques (89%). Robotic bronchoscopy (15%) and cone-beam CT (8%) are almost exclusively used in the USA where, respectively, 60% and 37% of respondents reported using these modalities. Ten percent of IP currently had access to endoscopic treatment modalities for PPL. However, half of the remaining IP plan to acquire an endoscopic treatment modality in the next 2 years. Conclusion: Available techniques and practices worldwide vary significantly regarding PPL investigation and treatment.

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Diagnostic yield and safety of navigation bronchoscopy: A systematic review and meta-analysis

Cited by 25 publications

References 105 publications

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

Rapid on‐site evaluation of touch imprint cytology in navigation bronchoscopy for small peripheral pulmonary nodules

An International Survey of Practices in the Investigation and Endoscopic Treatment of Peripheral Pulmonary Lesions amongst Interventional Bronchoscopists

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