Multimodality-guided Transbronchial Lung Biopsy in Peripheral Pulmonary Nodules: A Comparison Between using an Electromagnetic Navigation Bronchoscopy and a Thin Bronchoscope
DOI:
https://doi.org/10.33192/Smj.2022.58Keywords:
ElElectromagnetic navigation, bronchoscopy, peripheral pulmonary nodule, navigation bronchoscopyAbstract
Objective: To compare the diagnostic yield of using a thin bronchoscope (TB) and ENB in the diagnosis of small PPNs combined with routine R-EBUS and fluoroscopy.
Materials and Methods: Patients with a PPN less than or equal to 30 mm were randomly assigned into 2 groups: 4 mm thin bronchoscope (TB group) and 5.9 mm conventional bronchoscope with an ENB (the superDimension®) system (ENB group).
Results: In total, 49 patients were enrolled and randomized into two groups: TB group (n = 24) and ENB group (n = 25). The mean size of the PPNs was 22 mm. There was no difference in nodule size, location of the nodules, the presence of computed tomography (CT) bronchus sign, and EBUS location between the groups. The diagnostic yields were 73.9% and 66.7% in the TB group and ENB group, respectively. There was no statistically significant difference in the diagnostic yield between the two groups. Multivariate analysis showed that the diagnostic yield
was significantly higher when there was also a CT bronchus sign (odds ratio 48.82, p = 0.031) and when the bronchoscope could reach a greater airway depth (odds ratio 6.21, p = 0.023). The overall complication was 2%, which was pneumothorax in one patient in the TB group.
Conclusion: Multimodality-guided techniques can improve the diagnostic yield in the diagnosis of PPNs. The PPNs larger than 2 cm with the presence of CT bronchus sign, the ENB provides a similar diagnostic yield compared to the thin bronchoscope. Further analysis and adequately powered prospective studies are required to confirm the advantages of ENB.
References
Wang Memoli JS, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest. 2012;142(2):385-93.
Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, Ost DE. American College of Chest Physicians Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):108S-130S.
Rivera MP, Mehta AC. American College of Chest Physicians Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):131S-148S.
Disayabutr S, Tscheikuna J, Nana A. The endobronchial ultrasoundguided transbronchial lung biopsy in peripheral pulmonary lesions. J Med Assoc Thai. 2010;93(Suppl 1):S94-S101.
Czarnecka K, Yasufuku K. Interventional pulmonology: focus on pulmonary diagnostics. Respirology. 2013;18(1):47-60.
Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ando M. Randomized study of endobronchial ultrasoundguided transbronchial biopsy: thin bronchoscopic method versus guide sheath method. J Thorac Oncol. 2012;7(3):535-41.
Eberhardt R, Anantham D, Ernst A, Feller-Kopman D, Herth F. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med. 2007;176(1):36-41.
Chen A, Chenna P, Loiselle A, Massoni J, Mayse M, Misselhorn D. Radial probe endobronchial ultrasound for peripheral pulmonary lesions. A 5-year institutional experience. Ann Am Thorac Soc. 2014;11(4):578-82.
Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J. 2011;37(4):902-10.
Tanner NT, Yarmus L, Chen A, Wang Memoli J, Mehta HJ, Pastis NJ, et al. Standard Bronchoscopy with fluoroscopy vs thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: A multicenter, prospective, randomized trial. Chest. 2018;154(5):1035-43.
Oki M, Saka H. Diagnostic value of ultrathin bronchoscopy in peripheral pulmonary lesions: a narrative review. J Thorac Dis. 2020;12(12):7675-82.
Oki M, Saka H, Ando M, Asano F, Kurimoto N, Morita K, et al. Ultrathin Bronchoscopy with Multimodal Devices for Peripheral PulmonaryLesions. A Randomized Trial. Am J Respir Crit Care Med. 2015;192(4):468-76.
Ishida T, Asano F, Yamazaki K, Shinagawa N, Oizumi S, Moriya H, et al. Virtual navigation in Japan Trial Group. Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomized trial. Thorax. 2011;66(12):1072-7.
Lamprecht B, Porsch P, Wegleitner B, Strasser G, Kaiser B, Studnicka M. Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield. Respir Med. 2012;106(5):710-5.
Zhang W, Chen S, Dong X, Lei P. Meta-analysis of the diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules. J Thorac Dis. 2015;7(5):799-809.
Folch EE, Pritchett MA, Nead MA, Bowling MR, Murgu SD, Krimsky WS, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol. 2019;14(3):445-58.
Makris D, Scherpereel A, Leroy S, Bouchindhomme B, Faivre JB, Remy J, et al. Electromagnetic navigation diagnostic bronchoscopy for small peripheral lesions. Eur Respir J. 2007;29(6):1187-92.
Eberhardt R, Anantham D, Herth F, Feller-Kopman D, Ernst A,. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest. 2007;131(6):1800-5.
Gex G, Pralong JA, Combescure C, Seijo L, Rochat T, Soccal PM. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and metaanalysis. Respiration. 2014;87(2):165-76.
Ost DE, Ernst A, Lei X, Kovitz KL, Benzaquen S, Diaz-Mendoza J, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med. 2016;193(1):68-77.
Folch EE, Bowling MR, Pritchett MA, Murgu SD, Nead MA, Flandes J, et al. NAVIGATE Study Investigators. NAVIGATE 24-Month Results: Electromagnetic Navigation Bronchoscopy for Pulmonary Lesions at 37 Centers in Europe and the United States. J Thorac Oncol. 2022;17(4):519-31.
Seijo LM, de Torres JP, Lozano MD, Bastarri- ka G, Alcaide AB, Lacunza MM, et al. Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a bronchus sign on CT imaging. Chest 2010;138:1316-21.
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Users are free to share, copy, and redistribute all articles published in the Siriraj Medical Journal (SMJ) in any medium or format as long as you follow the following terms:
- Attribution — You must give appropriate credit, provide a link to the material, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the publisher endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
- NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
