Transthoracic Needle Aspiration Research Articles

Study on Computed Tomography (CT) Guided Transthoracic Fine Needle Aspiration Cytology (FNAC) in the Diagnosis of Intrathoracic Mass Lesions - Not Approachable by USG

Background: Intrathoracic mass is a general issue encountered by the physicians in whole world including Bangladesh. Accurate diagnosis is important for proper management. Percutaneous fine needle aspiration cytology (FNAC) has been extensively utilized and widely accepted as an important means of diagnostic technique. This study was performed to know and justify the computed tomography (CT) guided FNAC as a diagnostic modality for the diagnosis of intrathoracic masses which are non-approachable by ultrasonography (USG). Methods: It was a descriptive type of cross sectional study and conducted among 30 patients having ultrasonologically non approachable intrathoracic masses during the period of Feb 2016 to July 2016 in Combined Military Hospital (CMH), Dhaka considering selection criteria and informed written consent using purposive sampling technique. FNAC was done in all the patients. After further investigation, a definitive diagnosis was made. The analysis of the surgical specimen, the biopsy, the therapeutic response, and the clinical follow-up all contributed to the ultimate diagnosis. A comparison was done between the cytological and final diagnosis for thirty cases. Ethical issues were properly addressed. Results: Initially CT guided FNAC was carried out on all patients. Conclusive cytological diagnosis was possible in 28 patients yielding 93.33% diagnostic accuracy. FNAC diagnosed 24 cases as malignant intrathoracic mass, 04 as benign lesion and 02 undiagnosed due to inadequate tissue material. In final diagnosis 25(75%) diagnosed as malignant and 05(25%) diagnosed as benign. Diagnosis of two patients was impossible by FNAC due to inadequate tissue material. Conclusion: CT guided FNAC of intrathoracic mass allow early diagnosis with lesser trauma and lower cost. This procedure avoided more invasive diagnostic surgery. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 10-16

A Review on Lung Cancer with Emphasis on Current Treatment

Cancer is a broad term that refers to more than 277 types of cancer. It is a disease that results from a variety of causes, including mutations resulting from oncogene activation, tumor suppressor gene failure, or other factors. Mutations in these genes cause abnormal cell growth. Lung cancer is one of the leading causes of cancer in the world. Lung cancer, also known as lung cancer, is a lung disease caused by the uncontrolled growth of cells in tissues. Risk factors include smoking , exposure to radon gas, asbestos, secondhand smoke, and pollution. The two types of lung cancer are small cell lung cancer (SCLS) and non-small cell lung cancer (NSCLS). Common symptoms include cough, hemoptysis, weight loss, fatigue, fever or clubbing, hypercalcemia, myasthenic syndrome (muscle fatigue), and changes. Lung cancer is classified by histological type and stage using TNM (tumor, tumour, and metastasis). Treatment depends on the type of cancer and includes surgery, radiation and chemotherapy. Long-term intake of vitamin A, vitamin D, or vitamin E does not reduce the risk of lung cancer. Consuming more vegetables and fruits will reduce the risk. There is no clear link between diet and lung cancer. Most patients with advanced NSCLC who respond to surgery are treated with adjuvant chemotherapy. Histological diagnosis can be made by sputum cytology, thoracentesis, access to lymph nodes, bronchoscopy, transthoracic needle aspiration, video-assisted thoracoscopy or thoracotomy. Initial evaluation of metastatic disease is based on history and physical examination, chest examination, computed tomography, PET scan, and clear tissue of mediastinal involvement. Despite the interest in screening among scientists and doctors, there is no major organization recommending screening for early detection of lung cancer. Smoking is still an important part of primary prevention.

Navigational Bronchoscopy vs CT Scan-Guided Transthoracic Needle Biopsy for the Diagnosis of Indeterminate Lung Nodules: Protocol and Rationale for the Navigation Endoscopy to Reach Indeterminate Lung Nodules vs Transthoracic Needle Aspiration, a Randomized Controlled Study Multicenter Randomized Trial

Navigational Bronchoscopy vs CT Scan-Guided Transthoracic Needle Biopsy for the Diagnosis of Indeterminate Lung Nodules: Protocol and Rationale for the Navigation Endoscopy to Reach Indeterminate Lung Nodules vs Transthoracic Needle Aspiration, a Randomized Controlled Study Multicenter Randomized Trial

Diagnostic value of transthoracic needle biopsy in lung tumors.

Thoracic ultrasonography is widely used in imaging peripheral lesions and invasive interventional procedures. The aim of this study was to assess the diagnostic value of thoracic ultrasonography-guided transthoracic needle aspiration biopsy and the factors affecting the diagnosis of peripheral tumoral lung lesions. The lesion size, biopsy needle type, number of blocks, complications, and pathology results were compared in 83 patients between January 2015 and July 2018. The cases with pathological non-diagnosis and definite pathological diagnosis were determined. For the assessment of the factors affecting diagnosis, the size of the lesions and the biopsy needle type were evaluated. Biopsy preparations containing non-diagnostic atypical cells were referred to a cytopathologist. The effect of the cytopathological examination on the diagnosis was also evaluated. Pathological diagnosis was made in 66.3% of the cases; cell type could not be determined in 22.9% of the cases, and they were referred to a cytopathologist. After the cytopathologist's examination, the diagnosis rate increased to 80.7%. Diagnosis rates were higher when using tru-cut than Chiba and higher in cases with tumor size >2 cm than smaller. Thoracic ultrasonography-guided transthoracic needle aspiration biopsy is a preferred approach to the diagnosis of peripheral tumoral lung lesions, given its high diagnostic rate, in addition to being cheap, highly suitable for bedside use, and safe, and the lack of radiation exposure.

Diagnostic efficacy and safety of radial probe endobronchial ultrasound-guided transbronchial needle aspiration for adjacent lesions in segmental or subsegmental bronchi: a single-center retrospective study

BackgroundPeripheral lung lesions can be sampled using various techniques, including computer tomography-guided transthoracic needle aspiration, electromagnetic navigation bronchoscopy, virtual navigation bronchoscopy, and radial probe endobronchial ultrasound transbronchial lung biopsy. Mediastinal lesions can be sampled using techniques like convex probe endobronchial ultrasound-guided transbronchial needle aspiration (CEBUS-TBNA) and endoscopic ultrasound-fine-needle aspiration. However, effective, safe techniques for lesions adjacent to the segmental or subsegmental bronchi are lacking. Herein, we retrospectively evaluated the diagnostic yield and safety of radial probe endobronchial ultrasound-assisted transbronchial needle aspiration (REBUS-TBNA) for lesions adjacent to the segmental bronchi, and explored the factors related to diagnostic yield.MethodsWe retrospectively analyzed the diagnostic yield and safety of REBUS-TBNA cases performed in our department from January 2019 to December 2022. Observation group patients had undergone REBUS-TBNA for lesions adjacent to the segmental bronchi; control group patients had undergone CEBUS-TBNA for mediastinal or hilar lesions. Patient characteristics and lesion sizes, diagnostic yield, adverse events, and relations between diagnostic yield and clinical characteristics were analyzed.ResultsThere were not statistically significant between-group differences in sex, age, diagnostic yield, or rate of adverse events. The observation group (n = 25; 17 male, 8 female) had a mean age of 64.76 ± 10.75 years. The average lesion size was 4.66 ± 1.07 cm, and lesions were predominantly in the upper lobes (80%). REBUS-TBNA diagnostic yield was 84%, with no adverse events reported. Diagnostic yield was not associated with lesion size or extent of bronchial stenosis; however, it was positively correlated with number of punctures. Patients with > 3 punctures had a significantly higher diagnostic yield than those with ≤ 3 punctures.ConclusionsREBUS-TBNA is a safe, effective diagnostic technique, particularly for lesions adjacent to the segmental or subsegmental bronchi of the upper lobe. Performing more than three punctures during the procedure improves the diagnostic yield. Larger-scale studies are warranted to confirm these results, and to further explore the clinical value of REBUS-TBNA.

CT-Guided vs. Navigational Bronchoscopic Biopsies for Solitary Pulmonary Nodules: A Single-Institution Retrospective Comparison.

Lung cancer is the second most common cause of death by cancer. Multiple modalities can be used to obtain a tissue sample from a pulmonary nodule. We aimed to compare the yield and adverse events related to transthoracic needle aspiration (TTNA) and Electromagnetic Navigation Biopsy (ENB) at our institution. This was a single-center retrospective study in which all patients referred for evaluation of a pulmonary lesion over 5 years (1 January 2013 to 31 December 2018) were identified. Our primary outcome was to compare the accuracy of TTNA to that of ENB in establishing the diagnosis of pulmonary lesions. Secondary outcomes included the evaluation of the adverse events and the sensitivity, specificity, positive, and negative predictive value of each modality. A total of 1006 patients were analyzed. The mean age of patients in the TTNA and the ENB group was 67.2 ± 11.2 years and 68.3 ± 9.2 years respectively. Local anesthesia was predominantly used for TTNA and moderate sedation was more commonly used in the ENB group. We found ENB to have an accuracy of 57.1%, with a sensitivity of 40.0%, a specificity of 100.0%, a positive predictive value of 100.0%, and a negative predictive value of 40.0%. As for the TTNA, the accuracy was 75.9%, with a sensitivity of 77.5%, a specificity of 61.5%, a positive predictive value of 95.0%, and a negative predictive value of 22.5%. The rate of clinically significant complications was higher in the TTNA group (8.2%) as compared to the ENB group (4.7%) with a p-value < 0.001. TTNA was superior to ENB-guided biopsy for the diagnostic evaluation of lung nodules. However, the complication rate was much higher in the TTNA group as compared to the ENB group.

Sampling of Thoracic Lymph Nodes and Lung Lesions: Trends in Procedural Utilization

Background: Advances in bronchoscopy have impacted the practice patterns in the sampling of thoracic lymph nodes and lung lesions. Objectives: The aim of the study was to study the trends in utilization of mediastinoscopy, transthoracic needle aspiration (TTNA), and bronchoscopic transbronchial sampling. Methods: We conducted an analysis of patient claims for sampling of thoracic lymph nodes and lung lesions in the Medicare population and a sample of the commercial population between 2016 and 2020. We used Current Procedural Terminology codes to identify mediastinoscopy, TTNA, and bronchoscopic transbronchial sampling. Post-procedural pneumothorax rates were assessed by procedure type including subset analyses for patients with chronic obstructive pulmonary disease (COPD). Results: Between 2016 and 2020, utilization of mediastinoscopy has decreased in both the Medicare and commercial populations (−47.3% and −65.4%, respectively), while linear endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has increased only in the Medicare population (+28.2%). Percutaneous lung biopsy claims dropped by −17.0% in the Medicare and −41.22% in the commercial population. The use of bronchoscopic TBNA and forceps biopsy declined in both populations, but the reliance on a combination of guided technology (radial EBUS-guided and navigation) grew in the Medicare and commercial populations (+76.3% and +25%). Rates of post-procedural pneumothorax were significantly higher following percutaneous biopsy compared to bronchoscopic transbronchial biopsy. Conclusions: Linear EBUS-guided sampling has surpassed mediastinoscopy as the technique for sampling thoracic lymph nodes. Transbronchial lung sampling is increasingly being performed with guidance technology. This trend is aligned with favorable rates of post-procedure pneumothorax for transbronchial biopsy.

Hypoxemia After Endobronchial Valve Deployment for Persistent Air Leak

Endobronchial valves (EBVs) are a novel, minimally invasive bronchoscopic management technique for persistent air leaks that fail conservative therapy. Currently, 2 EBVs are available in the United States: the Spiration Valve System (Olympus, Redmond, WA) and the Zephyr Valve (Pulmonx, Redwood, CA). These valves are Food and Drug Administration-approved to reduce hyperinflation in emphysematous patients via bronchoscopic lung-volume reduction. However, more recently, the Spiration Valve has been granted a compassionate use exemption through the Food and Drug Administration for persistent postsurgical air leaks. Despite their popularity, these devices are not free from side effects. As an anesthesiologist, it is vital to be aware of the pathophysiology of this patient population so that safe and effective anesthetics may be provided during valve placement. Here, the use of EBVs is discussed in a patient who presented with a persistent air leak after a transthoracic needle aspiration that failed treatment due to persistent hypoxemia, warranting EBV removal.

Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients.

The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB). Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumothorax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was placed, and when patients who did not require chest tube placement were discharged. CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 ± 5.57). This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.

A rare case of opaque hemithorax

Opaque hemithorax itself presents a plethora of causes. The physicians often mistook opaque hemithorax as massive pleural effusion. But rare causes of opaque hemithorax should also be explored. Hydatidosis is one of the rare causes of opaque hemithorax. Hydatidosis remains the endemic disease in some regions of the world. The liver and the lungs are the most affected sites in adults. Very few cases have been described in literature regarding hydatid cysts presenting as opaque hemithorax. A 20-year-old nonsmoker male admitted in our hospital with complaints of shortness of breath and cough for the last 1 year. Chest x-ray was suggestive of left opaque hemithorax with contralateral mediastinal shift. Ultrasonography of the chest revealed multiple anechoic cystic lesions of varying size. Computed tomography chest suggested the presence of multiple multiloculated cystic lesions in the entire left hemithorax. Transthoracic needle aspiration fluid cytology gave the suspicion of parasitic cyst. On further workup, the hydatid serology was found to be positive. Our patient presented with opaque hemithorax, and further workup leads us to the diagnosis of pulmonary hydatidosis.

Respiratory Diseases and Their Diagnosis in Dogs: A Review

Respiratory affections are common in dogs. Very young and older dogs are at greater risk as compared to the adult ones. Constant exposure of the respiratory tract to the infectious agents, reaching the upper and lower respiratory tract aerogenously or hematogenously, makes the respiratory system vulnerable to injury. Clinical signs mainly seen in upper respiratory tract diseases involves nasal discharge (serous, mucopurulent or hemorrhagic), sneezing, facial deformity, stertor, lethargy, inappetence and rarely, central nervous system signs whereas additional signs present in lower tract diseases range from dyspnoea, costal or abdominal respiration, cough, nasal discharge and congestion, edema, consolidation of lungs and weight loss. Advanced tests involved in diagnosis of respiratory problems in veterinary practicpe are rhinoscopy, bronchoscopy, transthoracic fine needle aspiration cytology (FNAC) transtracheal wash and bronchoalveolar lavage fluid cytology and culture. This review discusses the causes of upper and lower respiratory tract disorders of canines and various diagnostic tests involved in their diagnosis.

ASSESSING THE DIAGNOSTIC YIELD AND SAFETY PROFILE OF A NEW ROBOTIC-ASSISTED BRONCHOSCOPY PROGRAM IN A HIGH-RISK PATIENT POPULATION

ASSESSING THE DIAGNOSTIC YIELD AND SAFETY PROFILE OF A NEW ROBOTIC-ASSISTED BRONCHOSCOPY PROGRAM IN A HIGH-RISK PATIENT POPULATION

Clinical utility of cryptococcal antigen detection in transthoracic needle aspirate by lateral flow assay for diagnosing non-HIV pulmonary cryptococcosis: A multicenter retrospective study.

Lateral flow immunoassay (LFA) detection of cryptococcal capsular polysaccharide antigen (CrAg) is reported to be the most rapid and convenient laboratory method for diagnosing cryptococcosis. Its clinical diagnostic use, however, is not well studied. We retrospectively analyzed the data from 97 patients with suspected pulmonary cryptococcosis (PC) at 2 tertiary care centers. CrAg in both serum and lung aspirate specimens were examined by LFA. We divided the patients who were diagnosed with PC into group I, patients positive for CrAg in both the serum and lung aspirate, and group II, patients positive for CrAg in the lung aspirate but not in the serum. We analyzed the differences in imaging distribution, morphological characteristics, and concomitant signs between the 2 groups. Of all 97 patients, 47 were diagnosed with PC. Lung aspirates were positive for CrAg in 46/47 patients with PC (sensitivity 97.9%, specificity 100%, positive predictive value = 100%, negative predictive value = 98%). There were no false positive results in the noncryptococcosis patients, revealing a diagnostic accuracy of 99%. Serum CrAg tests were positive in 36/47 patients with PC (sensitivity 76.6%, specificity 100%, accuracy 88.7%, positive predictive value = 100%, negative predictive value = 82%). Chest imaging data showed a statistically significant greater number of single lesions in group II than in group I (P < .05). More lesions accompanied by halo signs were showed in group I (P < .01), whereas more accompanied by pleural stretch signs were found in group II (P < .01). The LFA-positive rate of CrAg in lung aspirate samples was higher than that of the serum samples, especially in patients with single pulmonary lesion or in those accompanied by pleural stretch. The direct measurement of CrAg in lung aspirate is a rapid, useful alternative diagnostic method for PC confirmation.

Diagnostic accuracy and adequacy of peripheral pulmonary nodules samples obtained by transthoracic needle aspiration.

To examine the adequacy of samples and accuracy of transthoracic needle aspiration (TTNA) in patients with peripheral pulmonary nodule (PPN) diagnosis. This retrospective study included 248 patients who underwent TTNA of PPN and subsequent diagnostic and therapeutic surgical procedures during a 5-year period at the Institute for Pulmonary Diseases of Vojvodina. The following were analysed: adequacy of cytological samples for diagnosis and molecular testing, tumour localisation and dimensions, and cytological and histopathological characteristics. The adequacy of the cytological samples was 93.15%. The proportion of adequate-diagnostic samples was higher in patients in whom the largest diameter of the lesion was >4cm, and this difference showed statistical significance. Tumour localisation was not statistically significant for the adequacy of samples for cytological analysis. Cytological samples of lung adenocarcinoma had high projected adequacy for EGFR analyses of 91.55%, not dependent on the size and location of the lesion. The most commonly diagnosed lung tumour was adenocarcinoma (45.51%). Patients with a cytological diagnosis of non-small cell carcinoma not otherwise specified, after histopathological analyses, had adenocarcinoma in most cases (53.85%). The overall accuracy of TTNA in the diagnosis of PPN was 71%. The method's accuracy was 75.24% for malignant tumours, while it was 28.57% for benign tumours. The accuracy of cytological analysis for the histological type of tumour was 84.18%. Transthoracic needle aspiration with cytological analysis is an effective and highly sensitive method in determining the aetiology of PPN.

Robotic-assisted Bronchoscopy and Cone-beam CT: A Retrospective Series.

Robotic-assisted Bronchoscopy and Cone-beam CT: A Retrospective Series.

Staging and operability of primary lung cancer in Western Cape Province, South Africa.

Background Lung cancer is the leading cause of cancer-related death globally and in South Africa. Historically, the majority of patients diagnosed with lung cancer are incurable at presentation. Objectives To assess the tumour, nodes, metastasis (TNM) staging of lung cancer in a centre with access to both positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a structured diagnostic approach and to compare results with a historical cohort from 2009 from the same hospital. Methods A retrospective descriptive observational study was performed using the registry of a high-volume tertiary hospital’s weekly multidisciplinary thoracic oncology meeting (MDT). A structured diagnostic approach was used for staging purposes. All patients with a tissue diagnosis of primary lung cancer and adequate imaging (chest CT and/or PET-CT) who presented at the MDT during the period from 1 January - 31 December 2019 were included. Final staging and tissue diagnoses were documented and compared with a historical cohort from 2009 from the same institution. Results Adenocarcinoma was the most common subtype (38.8%; n=116). Less than a tenth of patients (6.3%; n=16/254) with non-small cell lung cancer had potentially curable lung cancer (stage IA to IIIA) at presentation, significantly less than the 2009 cohort (14.5%; n=25/173; p=0.007). The most common procedure administered on patients was transthoracic needle aspiration (37.54%; n=112), followed by conventional bronchoscopic needle aspiration or biopsy (20.4%; n=61), and EBUS-TBNA (17.1%; n=51/299). After PET-CT, 19/30 cases were upstaged including 9/18 from potentially resectable to unresectable. Two of these cases were down-staged to potentially resectable following EBUS-TBNA. Conclusion There was a significant decline in resectable and potentially curable lung cancer at presentation over a 10-year period. PET-CT and EBUS-TBNA improved the accuracy of non-small cell lung cancer staging among patients with resectable and potentially curable lung cancer but have exposed a higher stage profile.

Comparison of the Effectiveness of the Cell Block Method with Core Tissue Biopsy for Adequate Diagnosis of Lung Malignant

BACKGROUND: An adequate diagnosis of lung malignancy can be detected through examination of pleural fluid and Transthoracic needle aspiration (TTNA) based on the cell block method and tissue core biopsy. The cell block method is an immunocytochemical examination method that is useful for the adequate diagnosis of lung malignancy.&#x0D; AIM: This study was to compare the effectiveness of the cell block method with tissue core biopsy on pleural fluid cytology and TTNA cytology to establish the diagnosis of lung malignancy.&#x0D; METHODS: This study is a diagnostic test with an analytical cross-sectional approach on 15 respondents suspected of lung cancer at Dr. Moewardi Hospital Surakarta in September 2021. Subjects underwent pleural fluid cytology, TTNA cytology based on the cell block method, and tissue core biopsy examination. Data analysis used the Kappa test and bivariate analysis to calculate the p-value.&#x0D; RESULTS: The results of the combined examination of pleural fluid cytology and TTNA cytology based on the cell block method gave a very good level of conformity to the tissue core biopsy with a Kappa value of 0.857 and a p-value of 0.001. The results of the combined examination of pleural fluid cytology and TTNA cytology with cell block method showed the highest percentage for sensitivity (100%), NPV (100%), and accuracy (93%); while the results of the TTNA cytology examination using the cell block method showed the highest percentage of specificity (100%) and PPV (100%) of the tissue core biopsy method.&#x0D; CONCLUSION: The cell block method is very effective and significant in assessing the results of combined pleural fluid cytology and TTNA cytology against the tissue core biopsy method so that it is useful for the adequate diagnosis of lung malignant

Efficacy and safety of CT-guided percutaneous fine needle aspiration and biopsy for malignant pulmonary lesions

Background: CT-guided percutaneous transthoracic fine needle aspiration (FNA) and core biopsy (CB) are commonly used to characterise lung lesions. There is conflicting information on which method is superior and wide variation in reported complication rates. Our objectives were to establish the efficacy and safety of percutaneous CT-guided FNA and CB in the diagnosis of malignant lung lesions. Methods: This retrospective study included patients who underwent CT-guided percutaneous FNA and/or CB for lung parenchymal lesions at Kasturba Medical College Mangalore, from January 2013 to December 2020. Ethical clearance was obtained from the Institutional Ethics Committee. Efficacy was determined by the adequacy of samples, sensitivity, specificity and diagnostic accuracy. Safety was assessed using the incidence of complications. Results: A total of 326 patients underwent both FNA and CB, and 49 underwent FNA alone. Adequate samples were obtained in 82.9% of FNA cases and 95.7% of CB cases. Considering biopsy as the gold standard, the sensitivity, specificity and diagnostic accuracy of FNA for malignancy were 95.19%, 80% and 91.27%, respectively. Kappa agreement between the two methods was substantial (0.767). Pneumothorax was the only complication observed, and was seen in 31 patients (8.2%), of which only one required chest tube drainage. The incidence of pneumothorax was significantly higher in patients with pre-existing lung disease such as COPD/emphysema (p value 0.000), patients with smaller lesions (p = 0.009), and deeper lesions from the pleura (p &lt;0.0001). Conclusions: FNA and CB are both safe and effective procedures. In the absence of an onsite cytopathologist, we recommend a combination of both techniques.

Utility and safety of sole electromagnetic navigation bronchoscopy under moderate sedation for lung cancer diagnosis.

BackgroundElectromagnetic navigation bronchoscopy (ENB) is an emerging technique for diagnosing pulmonary lesions. However, limited data is available on its sole utility under a least invasive setting without general anesthesia. We aimed to evaluate the diagnostic performance and safety of sole ENB under moderate sedation for diagnosing pulmonary lesions suspicious for lung cancer and to determine clinical factors associated with a better diagnostic yield.MethodsWe performed a retrospective analysis of consecutive patients who underwent sole ENB under moderate sedation for lung lesion biopsy between August 2016 and June 2021 at Seoul National University Bundang Hospital, a tertiary center in South Korea. Diagnostic yield of the ENB-guided biopsy, safety endpoints defined by the incidence and severity of associated complications, and factors associated with higher diagnostic yield were evaluated.ResultsA total of 94 patients were evaluated. The final diagnostic yield of ENB was 81.5% (75/92), excluding two indeterminate cases. The diagnostic yield ranged from 79.8% to 81.9% assuming all indeterminate cases were false-negatives (79.8%) and true-negatives (81.9%). The sensitivity and specificity for malignancy were 77.6% (ranging from 75.6% to 77.6%) and 100%, respectively. Any-grade pneumothorax occurred in 4.3% of the patients, and 2.1% developed pneumothorax requiring additional intervention. Multivariable analyses identified the presence of a class 2 bronchus sign as the only significant predictor for a higher diagnostic yield (odds ratio =4.83, 95% CI: 1.16–20.12). The diagnostic yield of ENB among those with class 2 bronchus sign was 89.8% (53/59).ConclusionsSole ENB under moderate sedation for diagnosing pulmonary lesions displayed a good diagnostic yield and safety profile, thus confirming its utility in a least-invasive setting. Moreover, sole ENB could be possibly be superior to transthoracic needle aspiration for diagnosing lesions with class 2 bronchus sign accounting for similar yields and lower complication rates.

Innovations in Bronchoscopy: Robotic-assisted Bronchoscopy

Low-dose computed tomography screening for lung cancer has led to the increased detection of peripheral pulmonary nodules (PPN). Bronchoscopic modalities of PPN biopsy (ultrathin bronchoscope, radial endobronchial ultrasound, electromagnetic navigational bronchoscopy) have not consistently shown diagnostic yields as high as ultrasound- or computed tomography-guided transthoracic needle aspiration or surgical lung biopsy. Robotic-assisted bronchoscopy gained US Food and Drug Administration approval in 2018 and 2019, and preliminary data have shown an improvement in the ability to navigate to PPN, obtain a diagnosis and evaluate tissue for molecular markers, all while maintaining a safety profile similar to that of traditional bronchoscopic methods. In this article, we aim to briefly summarize the data available on this novel technology and its potential for future applications.