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      Diagnostic value of ultrathin bronchoscopy in peripheral pulmonary lesions: a narrative review

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          Abstract

          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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          Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule.

          Jessica Wang Memoli, Paul Nietert, Gerard Silvestri (2012)
          The detection of pulmonary nodules (PNs) is likely to increase, especially with the release of the National Lung Screen Trials. When tissue diagnosis is desired, transthoracic needle aspiration (TTNA) is recommended. Several guided-bronchoscopy technologies have been developed to improve the yield of transbronchial biopsy for PN diagnosis: electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope, and guide sheath. We undertook this meta-analysis to determine the overall diagnostic yield of guided bronchoscopy using one or a combination of the modalities described here. We performed a MEDLINE search using “bronchoscopy” and “solitary pulmonary nodule.” Studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules were included. The overall diagnostic yield and yield based on size were extracted. Adverse events, if reported, were recorded. Meta-analysis techniques incorporating inverse variance weighting and a random-effects meta-analysis approach were used. A total of 3,052 lesions from 39 studies were included. The pooled diagnostic yield was 70%, which is higher than the yield for traditional transbronchial biopsy. The yield increased as the lesion size increased. The pneumothorax rate was 1.5%, which is significantly smaller than that reported for TTNA. This meta-analysis shows that the diagnostic yield of guided bronchoscopic techniques is better than that of traditional transbronchial biopsy. Although the yield remains lower than that of TTNA, the procedural risk is lower. Guided bronchoscopy may be an alternative or be complementary to TTNA for tissue sampling of PN, but further study is needed to determine its role in the evaluation of peripheral pulmonary lesions.
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            Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis.

            Muhammad Ali, William Trick, Benjamin Mba … (2017)
            Tissue diagnosis of peripheral pulmonary lesions (PPLs) can be challenging. In the past, flexible bronchoscopy was commonly performed for this purpose but its diagnostic yield is suboptimal. This has led to the development of new bronchoscopic modalities such as radial endobronchial ultrasound (R-EBUS), electromagnetic navigation bronchoscopy (ENB) and virtual bronchoscopy (VB). We performed this meta-analysis using data from previously published R-EBUS studies, to determine its diagnostic yield and other performance characteristics. Ovid MEDLINE and PubMed databases were searched for R-EBUS studies in September 2016. Diagnostic yield was calculated by dividing the number of successful diagnoses by the total number of lesions. Meta-analysis was performed using MedCalc (Version 16.8). Inverse variance weighting was used to aggregate diagnostic yield proportions across studies. Publication bias was assessed using funnel plot and Duval and Tweedie's test. 57 studies with a total of 7872 lesions were included in the meta-analysis. These were published between October 2002 and August 2016. Overall weighted diagnostic yield for R-EBUS was 70.6% (95% CI: 68-73.1%). The diagnostic yield was significantly higher for lesions >2 cm in size, malignant in nature and those associated with a bronchus sign on computerized tomography (CT) scan. Diagnostic yield was also higher when R-EBUS probe was within the lesion as opposed to being adjacent to it. Overall complication rate was 2.8%. This is the largest meta-analysis performed to date, assessing the performance of R-EBUS for diagnosing PPLs. R-EBUS has a high diagnostic yield (70.6%) with a very low complication rate.
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              Ultrathin Bronchoscopy with Multimodal Devices for Peripheral Pulmonary Lesions. A Randomized Trial.

              Masahide Oki, Hideo Saka, Masahiko Ando … (2015)
              The combination of an ultrathin bronchoscope, navigational technology, and endobronchial ultrasound (EBUS) seems to combine the best of mutual abilities for evaluating peripheral pulmonary lesions, but ultrathin bronchoscopes that allow the use of EBUS have not been developed so far.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Thorac Dis
                Journal ID (iso-abbrev): J Thorac Dis
                Journal ID (publisher-id): JTD
                Title: Journal of Thoracic Disease
                Publisher: AME Publishing Company
                ISSN (Print): 2072-1439
                ISSN (Electronic): 2077-6624
                Publication date (Print and electronic): December 2020
                Publication date (Print): December 2020
                Volume: 12
                Issue: 12
                Pages: 7675-7682
                Affiliations
                [1 ]Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center , Nagoya, Japan;
                [2 ]Department of Respiratory Medicine, Matsunami General Hospital, Kasamatsu, Japan
                Author notes

                Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Masahide Oki, MD. Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. Email: masahideo@ 123456aol.com .
                Article
                Publisher ID: jtd-12-12-7675
                DOI: 10.21037/jtd-2020-abpd-001
                PMC ID: 7797850
                PubMed ID: 33447460
                SO-VID: 9fe34933-09de-4663-9a72-e903fd1b3194
                Copyright © 2020 Journal of Thoracic Disease. All rights reserved.
                License:

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                Date received : 15 November 2020
                Date accepted : 17 December 2020
                Categories
                Subject: Review Article on Advance in Bronchoscopy for Peripheral Pulmonary Diseases

                Keywords: bronchoscopy,endobronchial ultrasound (ebus),peripheral pulmonary lesions (ppls),ultrathin bronchoscope,virtual bronchoscopic navigation (vbn)
                Data availability:
                Keywords: bronchoscopy, endobronchial ultrasound (ebus), peripheral pulmonary lesions (ppls), ultrathin bronchoscope, virtual bronchoscopic navigation (vbn)

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