Value of virtual bronchoscopic navigation and transbronchial ultrasound-guided sheath-guided exploration in diagnosis of peripheral lung cancer

BACKGROUND Peripheral lung cancer poses a substantial harm to human health,and it is easy to become exacerbated,potentially threatening the life and safety of patients AIM To assess the value of virtual bronchoscopic navigation(VBN)combined with transbronchial ultrasound-guided sheath-guided(EBUS-GS)exploration in the diagnosis of peripheral lung cancer.METHODS A total of 236 patients with peripheral lung cancer(nodule diameter range,8-30 mm;diagnosed using high-resolution computed tomography)were selected from three centers between October 2018 and December 2019.Patients who underwent EBUS-GS exploration alone were included in a control group,and those who received VBN in combination with EBUS-GS exploration were included in an observation group.The diagnostic rate and total operating time of differentsubgroups of the two groups were compared,and the time needed to determine the lesion was recorded.RESULTS There were no significant differences in diagnosis rate or total operation time between the two groups(P>0.05),and the time needed to determine the lesion in the observation group was less than that of the control group(P<0.05).CONCLUSION The combined use of VBN and EBUS-GS exploration technology has little effect on the diagnosis rate and total operation time of peripheral lung cancer,but it significantly shortens the time needed to determine the lesion and is a valuable diagnostic method.

Virtual bronchoscopic navigation without fluoroscopy guidance for peripheral pulmonary lesions in inexperienced pulmonologist

Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.