Virtual Bronchoscopic Navigation Combined with Ultrathin Bronchoscopy. A Randomized Clinical Trial

Asano, Fumihiro; Shinagawa, Naofumi; Ishida, Takashi; Shindoh, Joe; Awata, Masaki; Tsuzuku, Akifumi; Oizumi, Satoshi; Morita, Satoshi

doi:10.1164/rccm.201211-2104oc

Cited by 145 publications

(162 citation statements)

References 37 publications

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“…In a randomized control trial, Oki and colleagues found that the diagnostic yield of transbronchial biopsies performed using multimodal devices (EBUS, fluoroscopy, and virtual bronchoscopic navigation guidance) was higher using the ultrathin bronchoscopy method (74%) compared to the combination of thin bronchoscopy with a guide sheath (59%) (43). While the addition of virtual bronchoscopic navigation alone to ultrathin bronchoscopy did not improve the overall diagnostic yield for peripheral pulmonary lesions, the subgroup of patients with lesions in the right upper lobe or peripheral third of the lung demonstrated higher yield with such a combination (44).…”

Section: Thin and Ultrathin Bronchoscopymentioning

confidence: 96%

Recent advances in diagnostic bronchoscopy

2016

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EBUSConvex-Probe EBUS is a technique that allows real-time sonographic visualization of peri-bronchial structures during bronchoscopy using an ultrasound transducer which is mounted at the tip of the bronchoscope (3). Its advent at the beginning of the 21st century dramatically changed Abstract: The field of diagnostic bronchoscopy has been revolutionized in the last decade primarily with the advent of endobronchial ultrasound (EBUS) but also with the addition of multiple different techniques for "guided-bronchoscopy". These advances have had a substantial impact in the management of lung cancer with bronchoscopy now providing both diagnosis and mediastinal staging in a single procedure.EBUS has, in fact, become the first choice for staging of the mediastinum over cervical mediastinoscopy (CM). Although EBUS is now a well-established technique, there are continuous efforts from the scientific community to improve its diagnostic performance, and these will be reviewed in this manuscript. The term "guided-bronchoscopy" was recently coined to describe a myriad of techniques that guide our bronchoscopes or bronchoscopic tools into the periphery of the lungs in addition to our conventional fluoroscopy.Electromagnetic and non-electromagnetic navigation, thin and ultrathin scopes, as well as radial-probe EBUS have collectively increased our yield for smaller peripheral lung lesions and continue to evolve.Despite this improved diagnostic yield, there is still ample room for improvement and newer techniques are under way. With new therapies available for patients with interstitial lung disease, achieving a specific histologic diagnosis is now of paramount importance. Given the high morbidity and mortality of surgical biopsies, bronchoscopic cryobiopsy is being rapidly adopted as a safer and effective alternative, and it is likely going to play a major role in the management of these diseases in the near future. This manuscript we will focus on recent advances in EBUS, guided-bronchoscopy, and the use of cryobiopsy.

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Section: Thin and Ultrathin Bronchoscopymentioning

confidence: 96%

Recent advances in diagnostic bronchoscopy

2016

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“…One study showed that in combination with ultrathin bronchoscopy, VBN did not improve the diagnostic yield for peripheral pulmonary lesions. 17) In our study, 5 cases were assisted by VBN but this factor may not affect the results. Thus, delicate route selection with VBN may not be necessary for PPLs that do not have a bronchus sign because GS-TBNA can reach the PPL directly by piercing through the bronchial wall.…”

Section: Discussionmentioning

confidence: 60%

Transbronchial Needle Aspiration through a Guide Sheath with Endobronchial Ultrasonography (GS-TBNA) for Peripheral Pulmonary Lesions

Takai

Izumo

Chavez

et al. 2014

Ann Thorac Cardiovasc Surg

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Purpose: Although, endobronchial ultrasonography with a guide sheath is becoming a common procedure for the diagnosis of peripheral pulmonary lesions, there remain to be some inaccuracies in cases wherein the probe is located outside the lesion. We tested whether adding transbronchial needle aspiration through a guide sheath to the conventional technique increases efficacy for diagnosing peripheral pulmonary lesions. Methods: We performed transbronchial needle aspiration through a guide sheath for 37 subjects with peripheral pulmonary lesions between September 2012 and April 2013. The devices used were as follows (all Olympus Ltd., Tokyo, Japan): 1T-260 or LF-TP bronchoscope, K203 guide sheath kit and NA-1C-1 needle apparatus, customized by cutting the guide sheath 30 mm from the proximal end to fit well with the needle. Results: The endobronchial ultrasound probe was located within the lesion in 21 cases (56.8%) and outside in 16 cases (43.2%). Overall accuracy was 86.5 percent; 90.5% in "within" cases compared to 81.3% in "outside" cases with no significant difference (P = 0.42). Pneumothorax occurred in 2 cases and pneumonia in 1 case. Conclusion: Transbronchial needle aspiration through a guide sheath is an effective and safe diagnostic procedure for peripheral pulmonary lesions, especially when the guide sheath is outside the lesion.

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“…For machinegenerated virtual bronchoscopic navigation (VBN), several systems are now available. Studies have shown the efficacy of VBN for lesions (4,(14)(15)(16). Electromagnetic navigation bronchoscopy is another modality for image guidance (17,18).…”

Section: Aspects Of Biopsymentioning

confidence: 99%