Chest
Original ResearchInterventional PulmonologyA Randomized Trial of CT Fluoroscopic-Guided Bronchoscopy vs Conventional Bronchoscopy in Patients With Suspected Lung Cancer
Section snippets
Materials and Methods
Consecutive patients from March 2001 to April 2004 with either peripheral pulmonary nodules (≤ 3 cm in size), peripheral masses (> 3 cm in size), or mediastinal lymphadenopathy (> 1 cm in diameter) with suspected cancer without a proven pathologic diagnosis were eligible. The inclusion criteria were age > 40 years, at least a 10–pack-year history of smoking, and the ability to tolerate video-assisted thoracoscopic surgery (VATS). This was defined as an estimated postoperative FEV1 of > 800 mL
Patient Characteristics
Seventy-two patients were eligible, and 50 patients were enrolled into the study (CT scan guidance, 26 patients; conventional bronchoscopy, 24 patients). Twenty-two patients declined to participate in the study. Two patients, one from each arm, could not complete the study. One patient was admitted to the medical ICU for treatment of pneumonia prior to the scheduled bronchoscopy and subsequently died. The other patient was randomized to the CT fluoroscopy arm, but significant hemoptysis
Discussion
This study is the first randomized, controlled trial comparing CT scan-guided bronchoscopy and conventional bronchoscopy. This study failed to demonstrate a benefit of CT scan guidance compared to conventional bronchoscopy for either peripheral or mediastinal nodal evaluation. However, when a confirmation of target entry was obtained by CT scan, the diagnostic accuracy was higher. On a per-lymph-node basis, there was a trend suggesting the superiority of CT scan guidance.
This study of CT
Acknowledgment
We thank Linda Rolnitzky, MS, Biostatistics, Department of Environmental Medicine, New York University School of Medicine, for her advice.
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2017, Current Problems in Diagnostic RadiologyCitation Excerpt :Conventional bronchoscopy is excellent in the evaluation of endobronchially visible lesions with a sensitivity of 88%, however, it is limited in the evaluation of small (<2 cm) peripheral pulmonary nodules with reported diagnostic yields of 33%2 and 34%.3 The use of computed tomography (CT) fluoroscopy combined with traditional bronchoscopy has had mixed results with CT guidance failing to increase the diagnostic yield in a randomized control study.4 Newer technologies with imaging guidance such as endobronchial ultrasonography (EBUS) and electromagnetic navigation bronchoscopy (ENB) have improved diagnostic yields for biopsies of both lymph nodes and pulmonary nodules.
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2013, Clinics in Chest MedicineComplications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE Registry
2013, ChestCitation Excerpt :Because the rate of TBBx and associated pneumothorax was low, no significant difference could be ascertained regarding the impact of fluoroscopy. The incidence of pneumothorax when TBBxs were performed in addition to EBUS-TBNA was 2.7%, which is similar to previous reports.13,26–32 However, in contrast to previous investigations,33,34 we found that the use of positive pressure ventilation in patients undergoing TBBx was not associated with increased pneumothorax risk.
The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules
2012, ChestCitation Excerpt :In nonscreening studies, the sensitivity of conventional bronchoscopy varies from 51% to 76%,9–14 which is much higher than the 13.5% in the NELSON trial. This can be explained by the fact that in the present study, only 2.8% of the nodules were > 30 mm, whereas in nonscreening studies, the size ranged from 48 to 72 mm.9,10,13,14 We also found fewer endobronchial abnormalities (7.3% vs 8%-64%).10–12
EBUS-GS with the GeneXpert MTB/RIF assay for diagnosis of Mycobacterium tuberculosis infection of isolated pulmonary nodules
2023, European Journal of Medical Research
The study was supported by the American Lung Association, Clinical Research Grant program, and by a Clinical Research Grant from General Electric, with Dr. Ost denoted as the investigator.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).