Abstract
Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources.
References
1.
Brambilla
E
, Travis
WD
. World cancer report 2014. In: Stewart
BW
, Wild
CP
, editors. World cancer report 2014
. Lyon, France
: International Agency for Research on Cancer
; 2014
.2.
Aberle
DR
, Adams
AM
, Berg
CD
, Black
WC
, Clapp
JD
, Fagerstrom
RM
, et al.; National Lung Screening Trial Research Team
. Reduced lung-cancer mortality with low-dose computed tomographic screening
. N Engl J Med
. 2011
Aug
;365
(5
):395
–409
.
[PubMed]
0028-47933.
Black
WC
, Gareen
IF
, Soneji
SS
, Sicks
JD
, Keeler
EB
, Aberle
DR
, et al.; National Lung Screening Trial Research Team
. Cost-effectiveness of ct screening in the national lung screening trial
. N Engl J Med
. 2014
Nov
;371
(19
):1793
–802
.
[PubMed]
0028-47934.
van den Bergh
KA
, Essink-Bot
ML
, Borsboom
GJ
, Th Scholten
E
, Prokop
M
, de Koning
HJ
, et al. Short-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON)
. Br J Cancer
. 2010
Jan
;102
(1
):27
–34
.
[PubMed]
0007-09205.
Tammemägi
MC
, Katki
HA
, Hocking
WG
, Church
TR
, Caporaso
N
, Kvale
PA
, et al. Selection criteria for lung-cancer screening
. N Engl J Med
. 2013
Feb
;368
(8
):728
–36
.
[PubMed]
0028-47936.
Xu
DM
, Gietema
H
, de Koning
H
, Vernhout
R
, Nackaerts
K
, Prokop
M
, et al. Nodule management protocol of the NELSON randomised lung cancer screening trial
. Lung Cancer
. 2006
Nov
;54
(2
):177
–84
.
[PubMed]
0169-50027.
Zhao
Y
, de Bock
GH
, Vliegenthart
R
, van Klaveren
RJ
, Wang
Y
, Bogoni
L
, et al. Performance of computer-aided detection of pulmonary nodules in low-dose CT: comparison with double reading by nodule volume
. Eur Radiol
. 2012
Oct
;22
(10
):2076
–84
.
[PubMed]
0938-79948.
Heuvelmans
MA
, Oudkerk
M
, de Bock
GH
, de Koning
HJ
, Xie
X
, van Ooijen
PM
, et al. Optimisation of volume-doubling time cutoff for fast-growing lung nodules in CT lung cancer screening reduces false-positive referrals
. Eur Radiol
. 2013
Jul
;23
(7
):1836
–45
.
[PubMed]
0938-79949.
Whitney
DH
, Elashoff
MR
, Porta-Smith
K
, Gower
AC
, Vachani
A
, Ferguson
JS
, et al. Derivation of a bronchial genomic classifier for lung cancer in a prospective study of patients undergoing diagnostic bronchoscopy
. BMC Med Genomics
. 2015
May
;8
(1
):18
.
[PubMed]
1755-879410.
Silvestri
GA
, Vachani
A
, Whitney
D
, Elashoff
M
, Porta Smith
K
, Ferguson
JS
, et al.; AEGIS Study Team
. A bronchial genomic classifier for the diagnostic evaluation of lung cancer
. N Engl J Med
. 2015
Jul
;373
(3
):243
–51
.
[PubMed]
0028-479311.
Chen
CH
, Cheng
WC
, Wu
BR
, Chen
CY
, Chen
WC
, Hsia
TC
, et al. Improved diagnostic yield of bronchoscopy in peripheral pulmonary lesions: combination of radial probe endobronchial ultrasound and rapid on-site evaluation
. J Thorac Dis
. 2015
Dec
;7
Suppl 4
:S418
–25
.
[PubMed]
2072-143912.
van ’t Westeinde
SC
, Horeweg
N
, Vernhout
RM
, Groen
HJ
, Lammers
JJ
, Weenink
C
, et al. The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules
. Chest
. 2012
Aug
;142
(2
):377
–84
.
[PubMed]
0012-369213.
Rivera
MP
, Mehta
AC
, Wahidi
MM
. Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2013
;143:e142S-165S.14.
Baaklini
WA
, Reinoso
MA
, Gorin
AB
, Sharafkaneh
A
, Manian
P
. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules
. Chest
. 2000
Apr
;117
(4
):1049
–54
.
[PubMed]
0012-369215.
Wang Memoli
JS
, Nietert
PJ
, Silvestri
GA
. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule
. Chest
. 2012
Aug
;142
(2
):385
–93
.
[PubMed]
0012-369216.
Asano
F
, Shinagawa
N
, Ishida
T
, Shindoh
J
, Anzai
M
, Tsuzuku
A
, et al. Virtual bronchoscopic navigation combined with ultrathin bronchoscopy. A randomized clinical trial
. Am J Respir Crit Care Med
. 2013
Aug
;188
(3
):327
–33
.
[PubMed]
1073-449X17.
Oki
M
, Saka
H
, Ando
M
, Asano
F
, Kurimoto
N
, Morita
K
, et al. Ultrathin bronchoscopy with multimodal devices for peripheral pulmonary lesions. A randomized trial
. Am J Respir Crit Care Med
. 2015
Aug
;192
(4
):468
–76
.
[PubMed]
1073-449X18.
Eberhardt
R
, Kahn
N
, Gompelmann
D
, Schumann
M
, Heussel
CP
, Herth
FJ
. LungPoint—a new approach to peripheral lesions
. J Thorac Oncol
. 2010
Oct
;5
(10
):1559
–63
.
[PubMed]
1556-086419.
Botero Zaccour
JA
, Rosell Gratacos
A
, Cubero de Frutos
N
, Lopez Lisbona
R
, Tazi Mezalek
R
. Conventional vs ultrathin bronchoscopy in the diagnosis of solitary pulmonary nodules (spn)
. Eur Respir J
. 2013
;•••
:42
.0903-193620.
Shinagawa
N
, Yamazaki
K
, Onodera
Y
, Asahina
H
, Kikuchi
E
, Asano
F
, et al. Factors related to diagnostic sensitivity using an ultrathin bronchoscope under CT guidance
. Chest
. 2007
Feb
;131
(2
):549
–53
.
[PubMed]
0012-369221.
Naidich
DP
, Sussman
R
, Kutcher
WL
, Aranda
CP
, Garay
SM
, Ettenger
NA
. Solitary pulmonary nodules. CT-bronchoscopic correlation
. Chest
. 1988
Mar
;93
(3
):595
–8
.
[PubMed]
0012-369222.
Seijo
LM
, de Torres
JP
, Lozano
MD
, Bastarrika
G
, Alcaide
AB
, Lacunza
MM
, et al. Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study
. Chest
. 2010
Dec
;138
(6
):1316
–21
.
[PubMed]
0012-369223.
Asano
F
, Matsuno
Y
, Tsuzuku
A
, Anzai
M
, Shinagawa
N
, Yamazaki
K
, et al. Diagnosis of peripheral pulmonary lesions using a bronchoscope insertion guidance system combined with endobronchial ultrasonography with a guide sheath
. Lung Cancer
. 2008
Jun
;60
(3
):366
–73
.
[PubMed]
0169-500224.
Yasuo
M
, Kobayashi
T
, Hama
M
, Ichiyama
T
, Horiuchi
T
, Yamamoto
H
, et al. Combination of virtual bronchoscopic navigation with conventional transbronchial needle aspiration in the diagnosis of peribronchial pulmonary lesions located in the middle third of the lungs
. Respir Investig
. 2016
Sep
;54
(5
):355
–63
.
[PubMed]
2212-534525.
Herth
FJ
, Eberhardt
R
, Sterman
D
, Silvestri
GA
, Hoffmann
H
, Shah
PL
. Bronchoscopic transparenchymal nodule access (BTPNA): first in human trial of a novel procedure for sampling solitary pulmonary nodules
. Thorax
. 2015
Apr
;70
(4
):326
–32
.
[PubMed]
0040-637626.
Harzheim
D
, Sterman
D
, Shah
PL
, Eberhardt
R
, Herth
FJ
. Bronchoscopic transparenchymal nodule access: feasibility and safety in an endoscopic unit
. Respiration
. 2016
;91
(4
):302
–6
.
[PubMed]
1423-035627.
Franke
KJ
, Linzenbold
W
, Nuessle
D
, Enderle
M
, Boesmueller
H
, Nilius
G
, et al. A new tool for transbronchial cryobiopsies in the lung: an experimental feasibility ex vivo study
. Respiration
. 2016
;91
(3
):228
–34
.
[PubMed]
1423-035628.
Diez-Ferrer
M
and Gil
D
, Tebe
C
, Sanchez
C
, Cubero
N
, Lopez-Lisbona
R
, Dorca
J
, Rosell
A.
Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation.
Accepted for publication in Respiration. doi: © 2018 S. Karger AG, Basel
2018
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