Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Abstract

385 PULMONARY PROCEDURESsuspicious for lung cancer. 2 With the fi ndings of the NLST indicating a reduction in lung-cancer-specifi c mortality with CT scanning in at-risk people, the number of patients diagnosed with a PN could increase substantially if screening for lung cancer is broadly T he pulmonary nodule (PN) is becoming an increasingly common radiographic fi nding among patients in the United States. Nearly 45 million CT scan examinations are performed each year, and 11% to 30% (4.5-14 million) of those include an examination of the chest. 1 In the recently released National Cancer Institute-sponsored National Lung Screening Trial (NLST), . 25% of the group who underwent lowdose CT scans of the chest had examinations that were Background: The detection of pulmonary nodules (PNs) is likely to increase, especially with the release of the National Lung Screen Trials. When tissue diagnosis is desired, transthoracic needle aspiration (TTNA) is recommended. Several guided-bronchoscopy technologies have been developed to improve the yield of transbronchial biopsy for PN diagnosis: electromagnetic navigation bronchoscopy (ENB ), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope, and guide sheath. We undertook this meta-analysis to determine the overall diagnostic yield of guided bronchoscopy using one or a combination of the modalities described here. Methods: We performed a MEDLINE search using "bronchoscopy" and "solitary pulmonary nodule." Studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules were included. The overall diagnostic yield and yield based on size were extracted. Adverse events, if reported, were recorded. Meta-analysis techniques incorporating inverse variance weighting and a random-effects meta-analysis approach were used. Results: A total of 3,052 lesions from 39 studies were included. The pooled diagnostic yield was 70%, which is higher than the yield for traditional transbronchial biopsy. The yield increased as the lesion size increased. The pneumothorax rate was 1.5%, which is signifi cantly smaller than that reported for TTNA. Conclusion: This meta-analysis shows that the diagnostic yield of guided bronchoscopic techniques is better than that of traditional transbronchial biopsy. Although the yield remains lower than that of TTNA, the procedural risk is lower. Guided bronchoscopy may be an alternative or be complementary to TTNA for tissue sampling of PN, but further study is needed to determine its role in the evaluation of peripheral pulmonary lesions.CHEST 2012; 142(2):385-393Abbreviations: ENB 5 electromagnetic navigation bronchoscopy; NLST 5 National Lung Screening Trial; PN 5 pulmonary nodule; R-EBUS 5 radial endobronchial ultrasound; TTNA 5 transthoracic needle aspiration; VB 5 virtual bronchoscopy

Diagnosing Lung Carcinomas with Optical Coherence Tomography

“…biopsy and fine needle aspiration (FNA) are often the only method of diagnosis for many patients with lung cancer (6)(7)(8). However, pathology diagnosis on these small specimens can be difficult because of inadequate tumor volume and/or lack of tissue architecture (1,(7)(8)(9)(10)(11)(12)(13)(14).…”

“…However, pathology diagnosis on these small specimens can be difficult because of inadequate tumor volume and/or lack of tissue architecture (1,(7)(8)(9)(10)(11)(12)(13)(14). When an equivocal diagnosis is made on biopsy/FNA specimens, patients often must undergo repeat biopsy or more invasive surgical procedures, such as thoracoscopic wedge resection, to obtain more tissue for definitive diagnosis.…”

New technologies in diagnostic bronchoscopy – an age of meta-analyses

“…This analysis confirms high diagnostic value, safety, and accuracy of rEBUS in diagnostics of peripheral lesions. More recent analysis [12] which evaluated various navigational techniques revealed quite similar results. The pooled sensitivity for all navigational techniques was 70% (having in mind that specificity is always 100%).…”

The role of bronchoscopy in the diagnosis of airway disease

“…A therapeutic bronchoscope with a 3.8-mm working channel is fitted with a steerable locatable guide that registers with the mat under the patient, which is then registered with the three dimensional reconstruction and pathways done during the planning stage (Figure 2). The location guide can extend out the end of the bronchoscope for biopsy out into more distal airways, reaching up to 6 th to 8 th generation airways (52).…”