Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomised trial

Background Bronchoscopy using endobronchial ultrasound (EBUS) can help to diagnose small peripheral pulmonary lesions. However, although biopsy sites can be confirmed, a bronchoscope cannot be guided in EBUS. Virtual bronchoscopic navigation (VBN) can guide a bronchoscope with virtual images, but its value has not been confirmed. Methods This prospective multicentre study examines the value of VBN-assisted EBUS for diagnosing small peripheral pulmonary lesions. 199 patients with small peripheral pulmonary lesions (diameter ≤30 mm) were randomly assigned to VBN-assisted (VBNA) or non-VBN-assisted (NVBNA) groups. A bronchoscope was introduced into the target bronchus of the VBNA group using the VBN system. Sites of specimen sampling were verified using EBUS with a guide sheath under fluoroscopy. Results The diagnostic yield was higher for the VBNA than for the NVBNA group (80.4% vs 67.0%; p=0.032). The duration of the examination and time elapsed until the start of sample collection were reduced in the VBNA compared with the NVBNA group (median (range), 24.0 (8.7–47.0) vs 26.2 (11.6–58.6) min, p=0.016) and 8.1 (2.8–39.2) vs 9.8 (2.3–42.3) min, p=0.045, respectively). The only adverse event was mild pneumothorax in a patient from the NVBNA group. Conclusions The diagnostic yield for small peripheral pulmonary lesions is increased when VBN is combined with EBUS. Clinical trial number UMIN000000569.

[1]  Diederick E Grobbee,et al.  Prevalence of Incidental Findings in Computed Tomographic Screening of the Chest: A Systematic Review , 2008, Journal of computer assisted tomography.

[2]  S. Gasparini,et al.  Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses. Experience with 1,027 consecutive cases. , 1995, Chest.

[3]  Daisuke Deguchi,et al.  A method for bronchoscope tracking by combining a position sensor and image registration. , 2005, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[4]  F. Herth,et al.  Electromagnetic Navigation during Flexible Bronchoscopy , 2003, Respiration.

[5]  K Neumann,et al.  Real-time interactive virtual endoscopy of the tracheo-bronchial system: influence of CT imaging protocols and observer ability. , 2000, European journal of radiology.

[6]  V Latrabe,et al.  CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. , 2000, Clinical radiology.

[7]  Paolo Battistoni,et al.  Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. , 2005, Chest.

[8]  L. Tanoue.  Cancer Statistics, 2009 , 2010 .

[9]  K. Ibukuro,et al.  Air embolism and needle track implantation complicating CT-guided percutaneous thoracic biopsy: single-institution experience. , 2009, AJR. American journal of roentgenology.

[10]  Ahuva Engel,et al.  Electromagnetic navigation during flexible bronchoscopy. Commentary , 2003 .

[11]  W. Baaklini,et al.  Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. , 2000, Chest.

[12]  Arnold Knijn,et al.  EUROCARE-4. Survival of cancer patients diagnosed in 1995-1999. Results and commentary. , 2009, European journal of cancer.

[13]  R. Yung.  Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy, transthoracic needle aspiration, and resectional biopsy. , 2003, Respiratory care clinics of North America.

[14]  Douglas C McCrory,et al.  Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. , 2003, Chest.

[15]  A. Ernst,et al.  Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study. , 2006, Chest.

[16]  W. Ajiki,et al.  Cancer incidence and incidence rates in Japan in 2002: based on data from 11 population-based cancer registries. , 2006, Japanese journal of clinical oncology.

[17]  Y. Ohno,et al.  CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. , 2003, AJR. American journal of roentgenology.

[18]  Atul C Mehta,et al.  Evidence-Based Clinical Practice Guidelines Initial Diagnosis of Lung Cancer : ACCP , 2007 .

[19]  A. Ernst,et al.  Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance , 2005 .

[20]  Koichi Yamazaki,et al.  Diagnosis of peripheral pulmonary lesions using a bronchoscope insertion guidance system combined with endobronchial ultrasonography with a guide sheath. , 2008, Lung cancer.

[21]  R. Choplin,et al.  Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. , 1999, Radiology.

[22]  Koichi Yamazaki,et al.  A virtual bronchoscopic navigation system for pulmonary peripheral lesions. , 2006, Chest.

[23]  Koichi Yamazaki,et al.  CT-guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation. , 2004, Chest.

[24]  F. Herth,et al.  Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions , 2002, European Respiratory Journal.

[25]  M. Munakata,et al.  A virtual bronchoscopic navigation system under X-ray fluoroscopy for transbronchial diagnosis of small peripheral pulmonary lesions. , 2007, Lung cancer.

[26]  F. Gleeson,et al.  Guidelines for radiologically guided lung biopsy , 2003, Thorax.

[27]  Claus Peter Heussel,et al.  LungPoint—A New Approach to Peripheral Lesions , 2010, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[28]  Masaki Murayama,et al.  Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. , 2004, Chest.

[29]  Daniel P Steinfort,et al.  Radiation dose to patients and clinicians during fluoroscopically-guided biopsy of peripheral pulmonary lesions. , 2010, Respiratory care.

[30]  Y. Onodera,et al.  Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions , 2004, European Respiratory Journal.

[31]  T. Miyazawa,et al.  Bronchoscopy in Japan: A survey by the Japan Society for Respiratory Endoscopy in 2006 , 2009, Respirology.

[32]  References , 1971 .

[33]  Ralf Eberhardt,et al.  Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. , 2007, American journal of respiratory and critical care medicine.

[34]  T. Gildea,et al.  Electromagnetic navigation diagnostic bronchoscopy: a prospective study. , 2006, American journal of respiratory and critical care medicine.

[35]  Yoichiro Ishihara,et al.  Transbronchial Diagnosis of A Pulmonary Peripheral Small Lesion Using an Ultrathin Bronchoscope with Virtual Bronchoscopic Navigation , 2002 .

[36]  Rebecca Bascom,et al.  Image-guided bronchoscopy for peripheral lung lesions: a phantom study. , 2008, Chest.

[37]  F Berrino,et al.  EUROCARE-3: survival of cancer patients diagnosed 1990-94--results and commentary. , 2003, Annals of oncology : official journal of the European Society for Medical Oncology.

[38]  Koichi Yamazaki,et al.  Transbronchial biopsy using endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation. , 2005, Chest.