Evaluation Of Peripheral Pulmonary Lesions Research Articles

Diagnostic outcomes of radial endobronchial ultrasound bronchoscopy guided by manual navigation in the evaluation of peripheral pulmonary lesions: An observational study.

Manual navigation (MN), drawing a bronchoscopic road map simply by looking at the consecutive computed tomography (CT), is feasible and economical. However, scant data about the use of MN in radial endobronchial ultrasound (r-EBUS) bronchoscopy have been documented till now. We aimed to evaluate the diagnostic performance of r-EBUS bronchoscopy guided by MN for diagnosing peripheral pulmonary lesions (PPLs) and to determine clinical factors affecting the diagnostic yield. We performed a retrospective, cohort study of consecutive patients with PPLs who underwent r-EBUS bronchoscopic biopsy via guidance of MN from May 2020 to June 2021 in our Respiratory Endoscopic Division. The overall diagnostic yield of MN-guided r-EBUS, the factors affecting the yield, and the diagnostic performance for malignancy were evaluated. A total of 102 patients (103 lesions) were evaluated. The overall diagnostic yield of MN-guided r-EBUS was 82.0%, and it ranged from 79.6% to 82.5%, assuming the undermined cases were all positive cases (79.6%) or negatives (82.5%). The sensitivity of MN-guided r-EBUS for malignancy was 71.4%, ranging from 68.2% to 71.4%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 67.3%, ranging from 63.8% to 69.0%. The multivariate logistic regression showed that "bronchus sign on CT" was the only predictor of the overall diagnostic yield (odds ratio = 11.5, 95% confidence interval: 1.9-70.9, P = 0.009). MN-guided r-EBUS is feasible in diagnosing PPLs, especially for lesions with bronchus sign on CT.

Comparison of ultrathin bronchoscopy with conventional bronchoscopy for the diagnostic value of peripheral pulmonary lesions

Objective: To assess and compare the diagnostic efficacy of next-generation ultrathin bronchoscopy (UTB) and conventional bronchoscopy (CB), both combined with radial endobronchial ultrasound (r-EBUS), in the evaluation of peripheral pulmonary lesions (PPL). Methods: A cohort of 39 patients with PPL who underwent multimodal bronchoscopy at Dushu Lake Hospital, Soochow University, from June 1, 2021 to May 31, 2023 was consecutively enrolled. A single bronchoscopist performed multimodal bronchoscopies using CB (external diameter 4.9 mm or 5.9 mm, working channel diameter 2 or 3 mm, CB group) for transbronchial biopsy under r-EBUS guidance (rEBUS-TBLB), followed by UTB (external diameter 3 mm, working channel diameter 1.7 mm, UTB group) for transbronchial biopsy under r-EBUS guidance. Pathological findings and a 6-month clinical follow-up were used as the gold standard to compare the diagnostic yield of biopsy specimens, ultrasound characteristics, and localization rates of the two bronchoscope types. The aim was to evaluate the clinical application value of UTB combined with r-EBUS. Binary variables were analysed using the McNemar test for paired data. Continuous variables or ranked data were analysed using the Wilcoxon signed-rank test for paired data. Results: The diagnostic yields for UTB and CB groups were 66.67% (26/39) and 30.77% (12/39), respectively, with the UTB group significantly surpassing the CB group (χ2=10.56, P=0.001, 1-β=0.968). r-EBUS with CB exhibited no visible lesion in 13 cases, adjacent to the lesion in 19 cases, and within the lesion in 7 cases.Substitution of UTB resulted in r-EBUS images changing from no visible lesion to adjacent to the lesion in 7 cases, from no visible lesion to within the lesion in 3 cases, and from adjacent to the lesion to within the lesion in 12 cases. The positioning of the r-EBUS probe in relation to the lesions improved significantly with UTB usage (Z=-4.46, P<0.001). Localization rates (number of patients with "within" or "adjacent to" the image/total number of patients) for UTB and CB were 92.30% (36/39) and 66.67% (26/39), respectively (χ2=8.10, P=0.002). UTB improved r-EBUS probe localization rates. The diagnostic yields of UTB were higher than CB for solid lesions, lesions>30 mm in diameter, non-upper lobar location, benign or malignant lesions and lesions with or without a bronchus sign. Conclusion: The UTB group demonstrated a significantly higher diagnostic yield than the CB group, providing superior r-EBUS probe images, and a significant diagnostic advantage for PPL.

The Use of Robotic-Assisted Bronchoscopy in the Diagnostic Evaluation of Peripheral Pulmonary Lesions: A Paradigm Shift

Despite recent developments, evaluation of peripheral pulmonary lesions (PPL) remains clinically challenging, and the diagnostic yield of many image-guided and bronchoscopy methods is still poor. Furthermore, complications from such procedures, such as pneumothorax and airway hemorrhage, are a major concern. Recently launched robotic-assisted bronchoscopy (RAB) platforms are still in the early exploration stage and may provide another tool for achieving PPL evaluation. We present our experience here as a retrospective cohort study describing the 12-month diagnostic yield with the shape-sensing Ion™ platform for minimally invasive peripheral lung biopsy. The study describes forty-two patients undergoing shape sensing robotic-assisted bronchoscopy (ssRAB) at our institute. The early performance trend reveals a lesion localization of 100% and an overall 12-month diagnostic yield of 88.10%. The diagnostic yield for lesions less than 20 mm was 76% and for lesions greater than 20 mm was 100%. We also report our complication profile; we noted no pneumothoraces, excessive bleeding, or post-operative complications. In comparison to traditional bronchoscopy and image-guided modalities, our experience shows that ssRAB can be utilized successfully to travel to extremely small peripheral lesions with a higher diagnostic yield and better safety profile.

Probe-based optical fiberscopy for the direct observation of peripheral pulmonary lesions.

Peripheral pulmonary lesions are rarely observed directly before transbronchial biopsy. This study aimed to characterize the differences between malignant and benign peripheral pulmonary lesions according to the findings of direct observation using probe-based optical fiberscopy. Thirty patients who underwent probe-based optical fiberscopy in combination with bronchoscopy using endobronchial ultrasonography with a guide sheath for the evaluation of peripheral pulmonary lesions were prospectively included in this study. The patients were divided into the malignant and benign groups according to their final diagnosis. The findings of probe-based optical fiberscopy in the two groups were compared. The numbers of patients who were diagnosed using histological or bacteriological analyses via bronchoscopic sampling in the malignant and benign groups were 20/23 (87.0%) and 2/7 (28.6%), respectively. On probe-based optical fiberscopy, angiogenesis and vascular engorgement were observed only in the malignant group. The disappearance of subepithelial microvessel transparency and presence of bronchiolar stenosis were observed more frequently in the malignant group (78.3% and 60.9%) than in the benign group (28.6% and 28.6%), whereas increased mucus secretion was observed more frequently in the benign group (71.4%) than in the malignant group (8.7%). These results suggest that the findings of direct observation using probe-based optical fiberscopy are useful for differentiating malignant from benign peripheral pulmonary lesions. UMIN-CTR; UMIN000018796; URL: https://www.umin.ac.jp/ctr/index.htm.

A retrospective study comparing the ultrathin versus conventional bronchoscope for performing radial endobronchial ultrasound in the evaluation of peripheral pulmonary lesions.

Background:Few studies have reported on the utility of ultrathin bronchoscopes (UTBs) for performing radial probe endobronchial ultrasound (EBUS). Herein, we describe our experience with UTB and conventional bronchoscope (CB) for performing radial EBUS.Materials and Methods:This was a retrospective study comparing the diagnostic yield of a prototype UTB (external diameter 3 mm, working channel diameter 1.7 mm) versus CBs (external diameter ≥4.9 mm) in performing radial EBUS for the evaluation of peripheral pulmonary lesions (PPLs). Fluoroscopic guidance was not available.Results:A total of 121 subjects (34, UTB; 87, CB; 69.4% males) with a mean (standard deviation [SD]) age of 55.2 (14.8) years underwent radial EBUS. The mean (SD) size of PPLs on computed tomography of the thorax was 22.2 (13.7) mm. The lesions were significantly smaller in the UTB group (16.4 vs 24.7 mm, P = 0.006). Eight lesions could be visualized within the lumen of the peripheral smaller bronchi with the UTB. The overall yield of radial EBUS was 52.9% and was similar in the two groups (UTB vs. CB, 55.9% vs. 51.7%; P = 0.7). The procedure time was significantly shorter in the UTB group. On multivariate logistic regression, the yield was similar in the two groups after adjusting for the size and location of the lesion and position of the radial probe in relation to the lesion.Conclusion:Despite smaller lesions, radial EBUS performed with the UTB was found to have similar efficacy to that performed with the CB. More lesions could be visualized endobronchially using the UTB making it an attractive alternative for performing radial EBUS.

Comparison of diagnostic yield and safety profile of radial endobronchial ultrasound-guided bronchoscopic lung biopsy with computed tomography-guided percutaneous needle biopsy in evaluation of peripheral pulmonary lesions: A randomized controlled trial.

Background:Peripheral pulmonary lesions (PPLs) pose a diagnostic challenge, and the optimal investigation in many such cases remains unclear. Computed tomography (CT)-guided percutaneous needle biopsy (CT-PNB) has been the modality of choice for such lesions with a high diagnostic accuracy but with high rates of pneumothorax. Endobronchial ultrasound (EBUS) with a radial probe is an alternate diagnostic modality with increased diagnostic yield of bronchoscopy in the evaluation of PPL. We conducted a randomized controlled trial comparing the diagnostic accuracy and complication rates of radial EBUS with CT-guided lung biopsy for the evaluation of PPL.Methods:Fifty patients with PPL surrounded by lung parenchyma on all sides were randomly assigned to either radial EBUS or CT-PNB group (25 each).Results:Both groups had similar clinicoradiologic characteristics. The diagnostic accuracy of radial EBUS was comparable to CT-PNB with no statistically significant difference (72 vs. 84%; P = 0.306). However, the yield was significantly lower in right upper lobe lesions (20% vs. 83.3%; P = 0.03). CT-PNB group had significantly higher pneumothorax rates than radial EBUS (20% vs. 0%; P = 0.03). The lesions that were more than 2 cm, those with ultrasound feature of continuous hyperechoic margin around the lesion (P = 0.007), and the position of the ultrasound probe within the lesion (P < 0.001) were associated with a higher diagnostic yield with radial EBUS.Conclusion:Our findings suggest that radial EBUS is a safer investigation than CT-PNB with a comparable diagnostic accuracy for PPL not abutting the chest wall (CTRI/2017/02/007762).

Radial Probe Endobronchial Ultrasound for Peripheral Pulmonary Lesions: Initial Experience in an Indian Tertiary Healthcare Centre

Introduction : Diagnosis of peripheral pulmonary nodules is confusing; therefore, an accurate and safe lung biopsy can prevent unnecessary invasive diagnostic procedures. This study soughtto study the diagnostic yield, sensitivity, specificity, and negative and positive predictive values (NPV and PPV) of radial probe endobronchial ultrasound (EBUS)-guided biopsy for peripheral pulmonary lesions. Materials and Methods: Patients referred to the Division of Pulmonary Medicine for evaluation of peripheral pulmonary lesions were subjected to radial probe EBUS-guided transbronchial lung biopsy under conscious sedation after reviewing positron emission tomography scan/computed tomography results. The obtained specimens were considered diagnostic when the cytological, histopathological, or microbiological diagnosis was consistent with the clinical presentations. Results: Totally, 14 procedures were performed on 13 patients with mean lesion size of 30.42 mm. Mean distance between the lesion and pleura was 1.17±0.68 cm, and the diagnostic yield of this technique was 78.57%. Furthermore, the sensitivity, specificity, and NPV were 70% (range: 34.75 to 93.33), 100% (range: 39.76 to 100), and 57.14% (range: 18.41 to 90.10), respectively. This procedure was not associated with any major complications. Conclusion: Radial probe EBUS with satisfactory diagnostic yield and low complication rate is a promising tool for early diagnosis of lung cancer.

Role of radial endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of pulmonary nodules: Case report and literature review.

The diagnosis of pulmonary nodules can be made using several methods including computed tomography (CT)-guided fine-needle aspiration (FNA), radial endobronchial ultrasound (EBUS)-guided sampling techniques (transbronchial lung biopsy [TBLB], transbronchial brush, bronchoalveolar lavage, or transbronchial needle aspiration [TBNA]), or occasionally with convex probe (CP) EBUS-TBNA. While CT-guided FNA is associated with a high (25%) rate of pneumothorax, the CP-EBUS cannot reach lesions beyond the interlobar region. Radial EBUS-guided TBLB and transbronchial brushing are excellent modalities in the evaluation of peripheral pulmonary lesions. However, these techniques cannot access lesions that are located adjacent to the proximal segmental bronchus, due to the presence of a cartilaginous wall. Herein, we describe a 58-year-old man, who presented with a lung nodule in the right middle lobe, wherein radial EBUS-guided TBNA proved to be the most appropriate diagnostic modality. We also discuss the current utility of radial EBUS-guided TBNA in day-to-day practice.

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

The detection of pulmonary nodules (PNs) is likely to increase, especially with the release of the National Lung Screen Trials. When tissue diagnosis is desired, transthoracic needle aspiration (TTNA) is recommended. Several guided-bronchoscopy technologies have been developed to improve the yield of transbronchial biopsy for PN diagnosis: electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope, and guide sheath. We undertook this meta-analysis to determine the overall diagnostic yield of guided bronchoscopy using one or a combination of the modalities described here. We performed a MEDLINE search using “bronchoscopy” and “solitary pulmonary nodule.” Studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules were included. The overall diagnostic yield and yield based on size were extracted. Adverse events, if reported, were recorded. Meta-analysis techniques incorporating inverse variance weighting and a random-effects meta-analysis approach were used. A total of 3,052 lesions from 39 studies were included. The pooled diagnostic yield was 70%, which is higher than the yield for traditional transbronchial biopsy. The yield increased as the lesion size increased. The pneumothorax rate was 1.5%, which is significantly smaller than that reported for TTNA. This meta-analysis shows that the diagnostic yield of guided bronchoscopic techniques is better than that of traditional transbronchial biopsy. Although the yield remains lower than that of TTNA, the procedural risk is lower. Guided bronchoscopy may be an alternative or be complementary to TTNA for tissue sampling of PN, but further study is needed to determine its role in the evaluation of peripheral pulmonary lesions.

Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis

Selection of the optimal procedure for minimally invasive diagnosis of peripheral pulmonary lesions (PPLs) may be based on clinical factors; however, selection of diagnostic strategy may also be influenced by cost. Economic analysis of minimally invasive diagnosis of PPL has not been performed previously. Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) with computed tomography-guided percutaneous needle biopsy (CT-PNB). Calculations were based on real costs derived from patient data. Sensitivity analyses and probabilistic sensitivity analysis were undertaken to identify the more cost-beneficial approach for varying input parameter values. Cost-effectiveness calculations were based on estimated disutility, according to the wait-trade-off technique. For base-case analysis, initial evaluation with CT-PNB was cost-beneficial (AU$2,724 versus EBUS-TBLB AU$2,748). The variable which exerted the most influence on cost-benefit outcomes was the cost of managing complications. CT-PNB remained the more cost-effective procedure at base-case parameters, although thresholds were identified during sensitivity analysis where EBUS-TBLB became more cost-effective. The costs of EBUS-TBLB and CT-PNB to evaluate PPL appear to be equivalent, but specific clinical-radiologic factors known to influence procedural outcomes will influence cost-benefit outcomes. Further evaluation of patient preferences and their influence on cost-effectiveness are required.

Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: A randomized pragmatic trial

In many patients the optimal method of investigation of peripheral pulmonary lesions (PPL) is not clear. We performed a prospective randomized pragmatic trial to determine the comparative effectiveness of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) and CT-guided percutaneous needle biopsy (CT-PNB) for the investigation of PPL. Overall complication rates were higher in those undergoing CT-PNB (27% v 3%, p = 0.03), while diagnostic accuracy of EBUS-TBLB was shown to be non-inferior to that of CT-PNB. Expected diagnostic accuracy and complication rates are likely to differ for individual patients on the basis of specific complex clinicoradiologic factors, which will influence the cost-benefit analysis between EBUS-TBLB and CT-PNB for individual patients. Further studies are required to examine the effect of these factors on clinical decision-making.

Endobronchial Ultrasound: Current Applications and Future Directions

Endobronchial ultrasound (EBUS) is an emerging diagnostic modality that allows the bronchoscopist visual, diagnostic, and therapeutic access to the majority of intrathoracic structures. Significant advances in the technology over the past several years have improved both the efficiency and accuracy of the technique. At present, the emerging body of evidence on EBUS suggests that in its 3 primary applications: (1) the evaluation of mediastinal structures, (2) the evaluation of peripheral pulmonary lesions and (3) use in therapeutic interventions; it improves the diagnostic yield and also the safety and utility of these procedures. The recent arrival of real-time EBUS allows for the simultaneous generation of ultrasound images and acquisition of diagnostic material by transbronchial needle aspiration. This has taken EBUS to another level as a diagnostic tool.

Gallium-67 as a diagnostic tool in the evaluation of peripheral pulmonary lesions.

<b>le Roux, B. T., and Houlder, A. E. (1974).</b><i>Thorax</i>, <b>29</b>, 355-358. <b>Gallium-67 as a diagnostic tool in the evaluation of peripheral pulmonary lesions.</b> While Gallium-67 shows a high affinity for primary pulmonary tumours, benign pulmonary lesions also concentrate the isotope. In 50 consecutive patients in whom the diagnosis of pulmonary carcinoma was not achieved by other means, the exhibition of ⁶⁷Ga showed a positive scan in 36, of whom three, on histological evidence, certainly did not have a pulmonary carcinoma, and in three others radiographic diminution in the extent of the peripheral pulmonary lesion makes most unlikely the diagnosis of carcinoma. In seven of 14 patients in whom the scan was negative it was judged necessary to undertake surgical management. Scanning with ⁶⁷Ga may modify the extent of surgical resection in some with a negative scan but does not establish the diagnosis of carcinoma in those with a positive scan, is unsafe as a screening test on which to base the decision on the need for referral to a thoracic surgeon, and in particular does not distinguish between the three common causes of `chronic lung abscess9—chronic destructive pneumonia, cavitated carcinoma, and tuberculosis with cavitation and without tubercle bacilli in the sputum.