Abstract
Background:
Flexible fiberoptic bronchoscope may be a valuable procedure to evaluate pulmonary nodules. However, a diagnostic yield has been reported as low as 34% for peripheral lesions less than 2 cm in size.
Objectives:
This case series study evaluated the value of the virtual bronchoscopic navigation (VBN) combined with endobronchial ultrasound (EBUS) for diagnosing peripheral pulmonary lesions.
Methods:
Enrolled subjects were patients with pulmonary lesions which were deemed too small and peripheral for a conventional bronchoscopic sampling, who were referred to Kameda Medical Center for diagnostic bronchoscopy between September 2010 and February 2012. VBN was utilized to produce a pathway into the target lesion. Once the fiberoptic bronchoscope was advanced as far as possible in this pathway, a guide sheath with EBUS probe was then advanced to the target lesion under fluoroscopy guidance. After visualization of the lesion by EBUS, the probe was removed leaving the guide sheath in place. Samplings were then performed through the guide sheath under fluoroscopic guidance.
Results:
Study subjects included 58 patients with 62 lesions, mean age 68 years. The mean lesion size was 20 mm in diameter. Bronchi seen on VB image were highly consistent with the actual structure. The sensitivity for diagnosing malignancy was 43% and negative predictive value was 61%. Overall accuracy for diagnosis of all lesions was 69%.
Conclusion:
VBN combined with EBUS is useful method for collecting samples from small peripheral pulmonary lesions and may help increase the diagnostic yield of transbronchial samplings in diagnosing small peripheral pulmonary lesions.
- © 2012 ERS
