Improving diagnostic yield of navigational bronchoscopy for peripheral pulmonary lesions: a review of advancing technology

Abstract

With recommendations for low dose CT scan for lung cancer screening, there has been an increase in the finding of lung nodules and peripheral pulmonary lesions (PPLs). Additionally, when there is concern for malignancy, guidelines have recommended performing the least invasive evaluation. Conventional bronchoscopy diagnostic yields for PPLs have reportedly been quite low and prior electromagnetic navigation bronchoscopy (ENB) studies have reported variable yields. Navigation bronchoscopy in addition to endobronchial ultrasound allows a physician to evaluate peripheral lung lesions along with mediastinal and hilar lymph nodes for the diagnosis and staging of suspected malignancy in one procedure. More recent advances in navigational bronchoscopy including the use of augmented fluoroscopy (AF), cone beam CT, and robotic bronchoscopy have pushed the boundaries of capability in evaluating PPLs.These added bronchoscopic technologies have shown to improve diagnostic yield especially when modalities are used in combination. The ultimate goal of endoscopically localized ablative and therapeutic treatment for peripheral lung lesions will require a high level of physician confidence, accuracy, and precision. This article will review the innovative characteristics and data of some of the more recently available navigational bronchoscopy devices.

Diagnostic value of ultrasound‐guided transbronchial lung biopsy in peripheral tuberculous pulmonary lesions

“…EBUS guided sampling technique has more advantages compared with fluoroscopy and CT guidance 21 . EBUS is a minimally invasive bronchoscopic technique that is increasingly used in the early diagnosis of PPLs.…”

“…EBUS guided sampling technique has more advantages compared with fluoroscopy and CT guidance. 21 EBUS is a minimally invasive bronchoscopic technique that is increasingly used in the early diagnosis of PPLs. The ultrasound probe used by EBUS is based on the different penetration, absorption, scattering, and reflection abilities of ultrasound in different tissues, forming a characteristic acoustic spectral image of tissue structure.…”

Safety and Diagnostic Yield of Radial Probe Endobronchial Ultrasound-Guided Biopsy for Peripheral Lung Lesions in Patients with Idiopathic Pulmonary Fibrosis: A Multicenter Cross-Sectional Study

“…Third, the number of patients in the probable UIP group was insufficient for generalization of the results. Fourth, all procedures using RP-EBUS were performed without the assistance of advanced bronchoscopy modalities for the diagnosis of PLL, such as electromagnetic navigation bronchoscopy or cone beam CT [28]. It will be necessary to verify and improve upon procedures in further prospective studies using both RP-EBUS and novel bronchoscopy modalities, such as robotic bronchoscopy or navigation bronchoscopy, based on multidisciplinary diagnosis of ILD.…”

Diagnostic Value and Safety of CT and US-Guided PTNB for Peripheral Pulmonary Lesions: A Meta-Analysis and Clinical Study

“…The early stage of lung cancer mostly appears in the form of lung nodules, which are not clinically obvious and have a high underdiagnosis rate, and the extensive local invasiveness and distant metastasis are the reasons for the poor prognosis of lung cancer, therefore, early detection and diagnosis are important for the treatment of the disease [1] [2]. With the widespread use of low-dose computed tomography (LDCT) for lung cancer screening, the detection of peripheral pulmonary lesions (PPL) is increasing, and LDCT in high-risk groups can reduce the mortality rate of lung cancer by 20% [3] [4] [5]. Currently, pathological diagnosis is still the gold standard for lung cancer diagnosis, and more specimens are needed to evaluate targeted therapies based on the latest advances in EGFR, ROS1, gene PD-1 and other current lung cancer targeted therapies and immunotherapy.…”