Virtual bronchoscopic navigation: advantages and limitations for the diagnosis of peripheral pulmonary lesions

Abstract

Background: Several novel methods have been proposed to improve the diagnostic yield of transbronchial biopsy for peripheral pulmonary lesions (PPL). LungPoint® virtual bronchoscopic navigation (VBN) uses virtual 3-dimensional reconstruction of the bronchial tree to guide a bronchoscope visually to the lesion. Objective: To analyse the advantages and limitations of VBN for the diagnosis of PPL. Methods: Nineteen consecutive patients with PPL smaller than 35mm were referred to bronchoscopy with VBN. The distance from the last reconstructed bronchus to the lesion was calculated by the VBN system prior to the procedure. A total of 12 cases with a calculated distance less than 15 mm were included in the analysis. In eight patients radial endobronchial ultrasound (R-EBUS) was used to confirm the location of the lesion following virtual navigation. In all cases a definite diagnosis was achieved either by the bronchoscopic procedure or surgery. Results: The mean lesion diameter was 20 mm. Ten of the lesions were located in the right upper, one in the right middle, two in the right lower, five in the left upper, and one in the left lower lobe. The diagnostic yield of the VBN bronchoscopy was 66,7% (5 benign, 3 malignant lesions). In 5 (41,6%) cases the lesion could be visualized by R-EBUS. In all these cases a conclusive histopathologic diagnosis could be established by the bronchoscopy, leading to a diagnostic yield of 100%. Conclusions: A high diagnostic yield can be achieved with the virtual bronchoscopic navigation if the calculated distance from the last reconstructed bronchus to the lesion is less than 15 mm and the lesion site can be confirmed by R-EBUS.