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Comparison of ultrathin bronchoscopy with conventional bronchoscopy for the diagnosis of peripheral lung lesions without virtual bronchial navigation
Institution:1. Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Japan;2. Department of Pulmonary Medicine, Kushiro General Hospital, Japan;3. Department of Pulmonary Medicine, Shihoro General Hospital, Japan;4. Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Japan;1. Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia;2. Centre for Respiratory Health, University of Western Australia, Pleural Medicine Unit, Perth, Western Australia, Australia;3. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia;1. University of Pennsylvania Medical Center, Philadelphia, PA;2. Broncus Medical, Mountain View, CA;3. Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, Germany;4. Medical University of South Carolina, Charleston, SC;1. Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA;2. Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA;3. Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA;4. Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina, USA;1. Department of Respiratory Medicine, Tokyo Women׳s Medical University, Tokyo, Japan;2. Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;3. Tokyo Women׳s Medical University Institute for Integrated Medical Sciences, Tokyo, Japan;4. Department of Surgical Pathology, Tokyo Women׳s Medical University, Tokyo, Japan;5. Department of Medical Education, Tokyo Women׳s Medical University School of Medicine, Tokyo, Japan;6. Department of Thoracic Surgery, Tokyo Women׳s Medical University, Tokyo, Japan;1. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA;2. Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile;3. Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;4. Virginia Cancer Specialists, Inova Health, Fairfax, VA;5. Division of Pulmonary and Critical Care, University of Florida, Gainesville, FL;6. Division of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL
Abstract:BackgroundFor the precise management of advanced lung cancers, bronchoscopy with a high diagnostic yield and abundant tumor specimens are required. In recent years, new devices and techniques have been rapidly developed, including the endobronchial ultrasound (EBUS) using a guide sheath, virtual bronchoscopic navigation (VBN), and ultra-thin bronchoscope (UTB), for the diagnosis of peripheral pulmonary lesions (PPLs). These techniques increase the diagnostic yield for PPL, thus requiring fewer biopsy specimens.VBN is generally not available at the city hospitals in Japan. In this study, using fluoroscopy without VBN, we studied whether the histologic diagnostic yield of radial EBUS for PPLs would be higher using a UTB (without guide sheath) or conventional bronchoscope (CB) (with guide sheath).MethodsWe retrospectively reviewed consecutive patients with suspected lung cancer who underwent bronchoscopy at the Hakodate Goryoukaku Hospital from April 2017 to March 2019. We analyzed 168 patients—102 using UTB and 66 using CB.ResultsThe diagnostic yields for PPL were significantly higher in the UTB group than in the CB group (74.5% vs. 59.1%; P = 0.04). The median examination time was significantly longer in the UTB group than in the CB group (24 vs. 20 min; P = 0.01). There were no statistically significant differences in the complication rate between the UTB and CB groups (3.9% vs. 3.0%; P = 0.69).ConclusionsUTB had a significantly higher tissue diagnostic yield than CB, without the use of VBN.
Keywords:Lung cancer  Peripheral pulmonary lesion  Radial EBUS  Guide sheath  Ultrathin bronchoscopy  EBUS-GS"}  {"#name":"keyword"  "$":{"id":"kwrd0040"}  "$$":[{"#name":"text"  "_":"endobronchial ultrasound using a guide sheath  PPL"}  {"#name":"keyword"  "$":{"id":"kwrd0050"}  "$$":[{"#name":"text"  "_":"Peripheral pulmonary lesions  CB"}  {"#name":"keyword"  "$":{"id":"kwrd0060"}  "$$":[{"#name":"text"  "_":"Conventional bronchoscope  UTB"}  {"#name":"keyword"  "$":{"id":"kwrd0070"}  "$$":[{"#name":"text"  "_":"Ultrathin bronchoscope  rEBUS"}  {"#name":"keyword"  "$":{"id":"kwrd0080"}  "$$":[{"#name":"text"  "_":"radial EBUS  VBN"}  {"#name":"keyword"  "$":{"id":"kwrd0090"}  "$$":[{"#name":"text"  "_":"Virtual bronchoscopic navigation  CT"}  {"#name":"keyword"  "$":{"id":"kwrd0100"}  "$$":[{"#name":"text"  "_":"computed tomography
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