Background: Recent clinical trials demonstrated the benefits of several guided-bronchoscopy technologies for the diagnosis of peripheral pulmonary lesions (PPLs). However, introduction of these technologies is expensive. Therefore, in clinical practice, these are unavailable in many hospitals. In contrast, virtual bronchoscopy (VB) using the computed tomography (CT) workstation can be made available immediately without additional cost as many hospitals already have the CT scan facility. However, the effectiveness of VB alone remains to be shown. Objectives: The aim of this study was to investigate the effect of VB using the CT workstation in hospitals performing conventional bronchoscopy. Methods: Results from consecutive patients who underwent bronchoscopy for small PPLs (major diameter ≤30 mm) were retrospectively reviewed. Sixty-nine patients who underwent bronchoscopy without VB from April 2014 to March 2015 and 56 patients who underwent bronchoscopy with VB from April 2015 to December 2015 were assigned to non-VB and VB groups, respectively. We compared the two groups and analyzed the factors affecting the diagnostic yield. Results: The VB group had a significantly higher diagnostic yield than the non-VB group (57.1 vs. 33.3%; p = 0.008). In the multivariate analysis, VB was identified as a significant factor affecting the diagnostic yield (odds ratio: 3.30, p = 0.011). Conclusions: In the conventional bronchoscopy settings, VB using the CT workstation is efficient for the diagnosis of PPLs when other guided-bronchoscopy techniques are unavailable.

Keywords:
Virtual bronchoscopy, Computed tomography workstation, Conventional bronchoscopy, Clinical practice, Synapse Vincent volume analyzer, Peripheral pulmonary lesion, Cost
1.
Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395–409.
2.
Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS: Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e93S–e120S.
3.
Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC: Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol 2010; 21: 969–975.
4.
Matsuguma H, Nakahara R, Kondo T, Kamiyama Y, Mori K, Yokoi K: Risk of pleural recurrence after needle biopsy in patients with resected early stage lung cancer. Ann Thorac Surg 2005; 80: 2026–2031.
5.
Rivera MP, Mehta AC: Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132: 131s–148s.
6.
Paone G, Nicastri E, Lucantoni G, Dello Iacono R, Battistoni P, D’Angeli AL, Galluccio G: Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. Chest 2005; 128: 3551–3557.
7.
Kikuchi E, Yamazaki K, Sukoh N, Kikuchi J, Asahina H, Imura M, Onodera Y, Kurimoto N, Kinoshita I, Nishimura M: Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions. Eur Respir J 2004; 24: 533–537.
8.
Oki M, Saka H, Kitagawa C, Tanaka S, Shimokata T, Mori K, Kajikawa S: Novel thin bronchoscope with a 1.7-mm working channel for peripheral pulmonary lesions. Eur Respir J 2008; 32: 465–471.
9.
Oki M, Saka H, Ando M, Asano F, Kurimoto N, Morita K, Kitagawa C, Kogure Y, Miyazawa T: Ultrathin bronchoscopy with multimodal devices for peripheral pulmonary lesions. a randomized trial. Am J Respir Crit Care Med 2015; 192: 468–476.
10.
Gildea TR, Mazzone PJ, Karnak D, Meziane M, Mehta AC: Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med 2006; 174: 982–989.
11.
Eberhardt R, Anantham D, Ernst A, Feller-Kopman D, Herth F: Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 2007; 176: 36–41.
12.
Ishida T, Asano F, Yamazaki K, Shinagawa N, Oizumi S, Moriya H, Munakata M, Nishimura M: Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomised trial. Thorax 2011; 66: 1072–1077.
13.
Asano F, Shinagawa N, Ishida T, Shindoh J, Anzai M, Tsuzuku A, Oizumi S, Morita S: Virtual bronchoscopic navigation combined with ultrathin bronchoscopy. A randomized clinical trial. Am J Respir Crit Care Med 2013; 188: 327–333.
14.
Tamiya M, Okamoto N, Sasada S, Shiroyama T, Morishita N, Suzuki H, Yoshida E, Hirashima T, Kawahara K, Kawase I: Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under LungPoint guidance for small peripheral pulmonary lesions. Respirology 2013; 18: 834–839.
15.
Wang Memoli JS, Nietert PJ, Silvestri GA: Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest 2012; 142: 385–393.
16.
Matsumoto Y, Izumo T, Sasada S, Tsuchida T, Ohe Y: Diagnostic utility of endobronchial ultrasound with a guide sheath under the computed tomography workstation (Ziostation) for small peripheral pulmonary lesions. Clin Respir J 2017; 11: 185–192.
17.
Baaklini WA, Reinoso MA, Gorin AB, Sharaf kaneh A, Manian P: Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000; 117: 1049–1054.
18.
Schreiber G, McCrory DC: Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest 2003; 123: 115s–128s.
19.
Ogawa C, Minami Y, Morioka Y, Noda A, Arasawa S, Izuta M, Kubo A, Matsunaka T, Tamaki N, Shibatouge M, Kudo M: Virtual sonography for novice sonographers: usefulness of SYNAPSE VINCENT® with pre-check imaging of tumor location. Oncology 2014; 87(suppl 1): 50–54.
20.
Takenaka T, Yamazaki K, Miura N, Mori R, Takeo S: The prognostic impact of tumor volume in patients with clinical stage IA non-small cell lung cancer. J Thorac Oncol 2016; 11: 1074–1080.
21.
Sano A, Tsuchiya T: Virtual bronchoscopy using OsiriX. J Bronchol Interv Pulmonol 2014; 21: 113–116.
22.
Iwano S, Imaizumi K, Okada T, Hasegawa Y, Naganawa S: Virtual bronchoscopy-guided transbronchial biopsy for aiding the diagnosis of peripheral lung cancer. Eur J Radiol 2011; 79: 155–159.
23.
Fiorelli A, Raucci A, Cascone R, Reginelli A, Di Natale D, Santoriello C, Capuozzo A, Grassi R, Serra N, Polverino M, Santini M: Three-dimensional virtual bronchoscopy using a tablet computer to guide real-time transbronchial needle aspiration. Interact Cardiovasc Thorac Surg 2017; 24: 567–575.
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2018
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