Feasibility of manual bronchial branch reading technique in navigating conventional rEBUS bronchoscopy in the evaluation of peripheral pulmonary lesion

Abstract

Background Although radial endobronchial ultrasound (rEBUS) is an important verification tool in guided bronchoscopy, a navigational route was not provided. Manual airway mapping allows the bronchoscopist to translate the bronchial branching in computed tomography (CT) into a comparable bronchoscopic road map. We aimed to explore the feasibility of this technique in navigating conventional rEBUS bronchoscopy in the localisation of peripheral pulmonary lesion by determining navigation success and diagnostic yield. Methods Retrospective review of consecutive rEBUS bronchoscopy performed with a 6.2 mm conventional bronchoscope navigated via manual bronchial branch reading technique over 18 months. Results Ninety‐eight target lesions were included. Median lesion size was 2.67 cm (IQR 2.22‐3.38) with 96.9% demonstrating positive CT bronchus sign. Majority (86.7%) of lesions were situated in between the third and fifth airway generations. Procedure was performed with endotracheal intubation in 43.9% and fluoroscopy in 72.4%. 98.9% of lesions were successfully navigated and verified by rEBUS following the pre‐planned airway road map. Bidirectional guiding device was employed in 29.6% of cases. Clinical diagnosis was secured in 88.8% of cases, majority of which were malignant disease. The discrepancy between navigation success and diagnostic yield was 10.1%. Target PPL located within five airway generations was associated with better diagnostic yield (95.1% vs. 58.8%, P < 0.001). There was 1 (1.0%) pneumothorax in our cohort. Conclusions Manual bronchial branch reading technique in combination with conventional rEBUS is feasible in localisation of PPL, especially for lesions located within the first five airway generations

Endobronchial removal of the peripherally located foreign body with the ultrathin bronchoscopy and ultrathin cryoprobe guided by a manual navigating method: A case report

“…The manual navigating method, which has not been widely applied, is not only economical, but also brings a high navigation success rate and an increase diagnostic yield in peripheral pulmonary lesions. [10,11] In the case of the deformation and stenosis of the airways due to the significant granulation tissue in our case, we might not find out the lesion successfully without keeping the bronchial map at hand. To the best of our knowledge, its utility in removal of foreign bodies has not been reported.…”

Diagnostic outcomes of radial endobronchial ultrasound bronchoscopy guided by manual navigation in the evaluation of peripheral pulmonary lesions: An observational study

“…The univariate analysis in our study indicated that solid lesions, the presence of bronchus sign, and “within” in r‐EBUS image were associated with higher diagnostic yields, and PPLs located greater than or equal to fifth airway generation were negatively related to clinical yields. Kho et al 9 also determined the factors affecting the diagnostic yield of MN‐guided r‐EBUS and reported a significant higher yield in lesions located less than fifth airway generation. Similarly, the presence of bronchus sign and “within” in r‐EBUS image were reported to be positively related to the yields according a recent large meta‐analysis 13 .…”

“…Manual navigation (MN), drawing a schematic representation of the bronchial branching to reach the PPLs simply by looking at the consecutive CT, requires only paper and pencil 7 . This method is not only economical but also brings a high navigation success rate and an increase diagnostic yield in PPLs 8–10 . Unfortunately, scant data about this method have been documented till now.…”

“… 7 This method is not only economical but also brings a high navigation success rate and an increase diagnostic yield in PPLs. 8 , 9 , 10 Unfortunately, scant data about this method have been documented till now.…”

Inheritance and innovation of the diagnosis of peripheral pulmonary lesions

“…Currently, manual bronchial branch mapping techniques are emerging, which do not rely on the advanced navigational tools like VBN, and have been applied to EBUS-guided bronchoscopy. Kho et al 100 performed manual bronchial branch mapping of preoperative CT via the bronchial branch reading technology of DICOM software and then identified target lesions by EBUS according to the pre-planned airway road map, resulting in 98.9% successful rate. Our group created a hierarchical clock-scale hand-drawn mapping (HBN) for bronchoscopic navigation.…”