Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield

• Published in: Respiration Vol. 97; no. 3; pp. 252 - 258
• Main Authors: Diez-Ferrer, Marta, Morales, Arturo, Tebé, Cristian, Cubero, Noelia, López-Lisbona, Rosa, Padrones, Susana, Aso, Samantha, Dorca, Jordi, Gil, Debora, Rosell, Antoni
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.03.2019
• Subjects: Aged; Bronchoscopes; Bronchoscopy; Bronchoscopy - methods; Diagnosis; Endosonography - methods; Equipment Design; Female; Fluoroscopy; Follow-Up Studies; Humans; Image-Guided Biopsy - methods; Interventional Pulmonology; Lung cancer; Lung Neoplasms - diagnosis; Male; Methods; Prospective Studies; Reproducibility of Results; Tomography, X-Ray Computed; Virtual Reality; Spain; Bronchoscopy; Virtual bronchoscopic navigation; Ultrathin bronchoscopy; Diagnosis; Lung cancer; Peripheral lung lesion
• ISSN: 0025-7931; 1423-0356; 1423-0356
• DOI: 10.1159/000493270

Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources.