Does the Addition of Radial Endobronchial Ultrasound Improve the Diagnostic Yield of Electromagnetic Navigation Bronchoscopy? A Systematic Review

Abstract

<b><i>Background:</i></b> Lung cancer is the leading cause of cancer-related death worldwide. Early diagnosis is crucial to increased survival rates. Radial endobronchial ultrasound (rEBUS) and electromagnetic navigation bronchoscopy (ENB) have been developed for the diagnosis of small lung lesions. The aim of this systematic review was to evaluate whether the combination of rEBUS and ENB is superior to ENB alone. <b><i>Method:</i></b> A systematic search was performed using MEDLINE, Embase, and Cochrane Library databases on “ENB,” and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The project was registered with PROSPERO, number CRD42020214682. <b><i>Results:</i></b> In total, 2,092 studies were identified through a literature search. Five studies were included in the final review. One study found that the addition of rEBUS increased diagnostic yield, while another concluded the converse. Three studies did not have significant results. Meta-analysis was not feasible due to heterogeneity and the small number of studies. <b><i>Conclusion:</i></b> As the current evidence on the topic is sparse and heterogeneous, it is not possible to conclude whether the addition of rEBUS to ENB has a significant impact on diagnostic yield. Further studies are needed to illuminate this question in order to ensure optimal choice of endoscopic technique as well as used time and resources. The project received funding from the Region of Southern Denmark’s PhD fund.

Optimal approach for diagnosing peripheral lung nodules by combining electromagnetic navigation bronchoscopy and radial probe endobronchial ultrasound

“…Moreover, the observation of smaller nodule sizes in the combination group suggests a possible inclination toward using the combination in challenging cases. Given that most of the previous literature has already shown that combining the two methods leads to better results but also increases costs and complication rates, we hypothesized that the combination may be unnecessary for simple cases 13–16 . Hence, it was identified that the characteristics correlated with a reduced diagnostic yield, and an additional subgroup analysis was conducted by specifically selecting nodules based on the outcomes of the multivariable analysis.…”

“…This allows an operator to confirm whether the target has been reached by providing ultrasound images 12 . Combining ENB and RP‐EBUS seems beneficial because it enables the performer to determine the correct bronchus, approach the lesion using ENB, and then confirm the lesion using RP‐EBUS 13 . Most previous studies have shown consistent results, suggesting that combining the two methods would be advantageous 14–16 .…”

Efficacy of Combining Multiple Electromagnetic Navigation Bronchoscopy Modalities for Diagnosing Lung Nodules

“…Another meta-analysis examined the additional advantage of R-EBUS (1.4 mm, 20 MHz, UM S20-17S; Olympus) in combination with ENB (SuperDimension). However, the results were not suitable for metaanalysis because of study heterogeneity and small sample sizes [15]. SuperDimension and Bronchus software were used to navigate to the target nodule, and an extended working channel (EWC) was lodged into the target lesion.…”

When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield?

“…It has been established that factors such as lesion size, radial endobronchial-ultrasound (rEBUS) and proximity to the hilum, as well as computed tomography (CT) bronchus sign (air-filled bronchus near the lesion as seen on CT), increase diagnostic yield in conventional bronchoscopy [ 3 , 4 , 5 , 6 ]. Although some studies have suggested that this is also the case in ENB [ 7 , 8 ] the conclusions have been based on data from operators with substantial prior experience in ENB.…”