Introduction to Journal of Thoracic Disease new column of advance in bronchoscopy for peripheral pulmonary diseases.
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ABSTRACT:
SUBMITTER: Sun J
PROVIDER: S-EPMC7797842 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Introduction to <i>Journal of Thoracic Disease</i> new column of advance in bronchoscopy for peripheral pulmonary diseases.
Journal of thoracic disease 20201201 12
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Project description:BackgroundAs lung cancers arising in a background of idiopathic pulmonary fibrosis (IPF) are known to show high malignancy grades, early pathologic diagnosis of peripheral pulmonary lesions (PPLs) is important. Meanwhile, the risk of complications associated with diagnostic procedures is high, which prompted us to investigate the role of bronchoscopy, a relatively safe diagnostic procedure. Therefore, we conducted this study to evaluate the usefulness of bronchoscopy for the diagnosis of PPLs in patients with IPF.MethodsData of consecutive patients with IPF who underwent bronchoscopy under radial endobronchial ultrasound (R-EBUS) guidance for PPLs at our institution between April 2014 and March 2019 were retrospectively reviewed. IPF was defined as usual interstitial pneumonia (UIP) or probable UIP, in accordance with the classification in the latest global guidelines. The diagnostic outcomes and the factors independently related to the diagnostic yield were analyzed.ResultsA total of 92 patients were included in the analysis. The median (range) size of the target PPLs was 27.1 (11.4-75.3) mm, and the diagnostic yield was 82.6%. Multivariable analysis identified a larger size [P=0.017; odds ratio (OR), 5.33; 95% confidence interval (CI), 1.29-22.01], positive bronchus sign (P=0.035; OR, 4.99; 95% CI, 1.12-22.18), and not involved with UIP/probable UIP pattern (P=0.023; OR and 95% CI, unmeasurable) as being associated with a significantly higher diagnostic yield. Meanwhile, none of the patients developed acute exacerbation of IPF or pneumothorax following the diagnostic bronchoscopy.ConclusionsBronchoscopy using R-EBUS was safe and showed an acceptable diagnostic yield for PPLs, even in patients with IPF.
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Project description:Flexible bronchoscopes are being continuously improved, and an ultrathin bronchoscope with a working channel that allows the use of a radial-type endobronchial ultrasound (EBUS) probe is now available. The ultrathin bronchoscope has good maneuverability for passing through the small bronchi and good accessibility to peripheral lung lesions. This utility is particularly enhanced when it is used with other imaging devices, such as EBUS and navigation devices. Multimodality bronchoscopy using an ultrathin bronchoscope leads to enhanced diagnostic yield.
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Project description:BackgroundUltrathin bronchoscopy (external diameter, ≤3.5 mm) is useful for the diagnosis of peripheral pulmonary lesions because of its good accessibility.ObjectivesWe performed a meta-analysis to investigate the diagnostic yield of ultrathin bronchoscopy for peripheral pulmonary lesions.MethodsWe performed a systematic search of MEDLINE and EMBASE (from inception to May 2021), and meta-analysis was performed using R software. The diagnostic yield was evaluated by dividing the number of successful diagnoses by the total number of lesions, and subgroup analysis was performed to identify related factors.ResultsNineteen studies with a total of 1,977 peripheral pulmonary lesions were included. The pooled diagnostic yield of ultrathin bronchoscopy was 0.65 (95% confidence interval, 0.60-0.70). Significant heterogeneity was observed among studies (χ2, 87.75; p < 0.01; I2, 79.5%). In a subgroup analysis, ultrathin bronchoscopy with 1.2 mm channel size showed a diagnostic yield of 0.61 (95% confidence interval, 0.53-0.68), whereas ultrathin bronchoscopy with 1.7 mm channel size showed 0.70 (95% confidence interval, 0.66-0.74) (χ2, 5.35; p = 0.02). In addition, there was a significant difference in diagnostic yield based on lesion size, histologic diagnosis (malignant vs. benign), bronchus sign, and lesion location from the hilum, whereas no significant difference was found based on lobar location. The overall complication rate of ultrathin bronchoscopy was 2.7% (pneumothorax, 1.1%).ConclusionsUltrathin bronchoscopy is an excellent tool for peripheral pulmonary lesion diagnosis with a low complication rate. The diagnostic yield of ultrathin bronchoscopy was significantly higher with larger channel size, which might be attributed to the availability of radial endobronchial ultrasound.
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Project description:BackgroundThe diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects.Research questionWhat is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs?Study design and methodsThis was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator.ResultsFifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred.InterpretationThis is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield.Clinical trial registrationClinicalTrials.gov; No.: NCT03727425; URL: www.clinicaltrials.gov.
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Project description:Rationale: Although previous studies have assessed the clinical or economic value of specific technologies, the economic value of improving sensitivity for malignancy in lung cancer diagnoses broadly across technologies is unclear. Objectives: To identify the economic value of improving sensitivity of bronchoscopy biopsy for the diagnosis of lung cancer. Methods: A decision analytic model was developed to quantify the economic value of increased sensitivity for malignancy for bronchoscopy biopsy of peripheral pulmonary lesions. Primary clinical outcomes included time to diagnosis and survival. Economic outcomes included 1) net monetary benefit (NMB), defined as the health benefits measured in quality-adjusted life-years (QALYs) times willingness to pay ($100,000/QALY) net of changes in medical costs; and 2) incremental cost-effectiveness ratio. A decision tree modeling framework with two Markov module branches was developed. The two Markov modules corresponded to patients with cancer who were 1) diagnosed and treated or 2) undiagnosed and remained untreated. Outcomes were measured from a U.S. payer perspective over 30 years. Results: Improving sensitivity for malignancy by 10 percentage points decreased average time to diagnosis for patients with lung cancer by 0.85 month (4 wk) and increased survival by 0.36 year (19 wk) because of faster treatment initiation. Overall health outcomes improved by 0.20 QALYs per patient. Cost increased by $6,727 per patient primarily through increased treatment costs among those diagnosed with cancer. Increasing sensitivity for malignancy by 10 percentage points improved NMB by $8,729 over 30 years (incremental cost-effectiveness ratio of $34,052), driven largely by improved sensitivity to early-stage cancer (stage-specific NMB, I/II, $19,805; III, $2,101; IV, -$1,438). Forty-two percent of overall NMB ($3,668) accrued within 5 years of biopsy. The relationship between change in sensitivity and NMB was approximately linear (1% vs. 10% sensitivity improvement corresponded to NMB of $885 vs. $8,729). The model was most sensitive to cancer treatment efficacy and follow-up time after a negative result. Conclusions: Increasing sensitivity of malignancy by 10 percentage points resulted in a $8,729 improvement in net economic value. Health systems can use this information when making decisions regarding the value of new bronchoscopy technologies.
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Project description:Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. "CT-to-body divergence" has been identified as a major limitation of this modality. In-tandem use of the ultrathin bronchoscope and radial endobronchial ultrasound probe has yielded only comparable results, attributable to the limited peripheral reach, device maneuverability, stability, and distractors like atelectasis. As such, experts have identified three key steps in peripheral nodule sampling-navigation (to the lesion), confirmation (of the correct location), and acquisition (tissue sampling by tools). Robotic bronchoscopy (RB) is a novel innovation that aspires to improve upon these aspects and consequently, achieve a better diagnostic yield. Through this publication, we aim to review the technical aspects, safety, feasibility, and early efficacy data for this new diagnostic modality.
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