Comparison of radial mini probe endobronchial ultrasound with and without virtual bronchoscopic navigation to sample peripheral pulmonary lesions; a retrospective analysis

Abstract

Background Peripheral pulmonary lesions (PPLs) are found ever more due to increasing use of screening CT and CT pulmonary angiogram. Different modalities are available to sample PPLs like transthoracic needle aspiration and bronchoscopic techniques including radial mini probe endobronchial ultrasound (R-EBUS) with or without guidance by fluoroscopy, electromagnetic navigation or virtual bronchoscopic navigation (VBN). VBN guides bronchoscope under direct vision and combining with R-EBUS may enhance diagnostic yield of PPLs Aim We compared diagnostic yield of R-EBUS with and without the addition of VBN to sample PPLs Methods We retrospectively analysed consecutive patients having R-EBUS from 01/02/2014 – 28/02/2015 and 10/11/2015 – 08/02/2016 and compared with a pilot trial of VBN at our institution from 01/03/2015 – 09/11/2015. For VBN, CT images were transferred to a workstation and LungPoint Broncus © was used to create a virtual pathway to PPL. Bronchoscopy was performed with VBN and R- EBUS guidance. No fluoroscopic guidance was used for either technique Results 8 patients had R-EBUS and 12 R-EBUS with VBN. VBN increased overall diagnostic yield of R-EBUS from 50% to 67%. Presence of bronchus sign on CT increased diagnostic yield of both R-EBUS and VBN to 60% and 75% respectively Conclusion R-EBUS is a safe technique to sample PPLs with minimal complications. VBN increases diagnostic yield of R-EBUS especially with bronchus sign. Utility of VBN is offset by it9s limited availability and higher cost. We acknowledge that our study size is small; well-designed prospective studies are needed to validate these findings.