title: Virtual bronchoscopic navigation improves the diagnostic yield of radial-endobronchial ultrasound for peripheral pulmonary lesions with involved bronchi on CT.
abstract: OBJECTIVE
  Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful.
  
  
  METHODS
  The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterior-anterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated.
  
  
  RESULTS
  Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026).
  
  
  CONCLUSIONS
  VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.
authors.affiliation: Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Asano
authors.forename: Naofumi
authors.initials: N
authors.lastname: Shinagawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishida
authors.forename: Akifumi
authors.initials: A
authors.lastname: Tsuzuku
authors.forename: Motoko
authors.initials: M
authors.lastname: Tachihara
authors.forename: Kenya
authors.initials: K
authors.lastname: Kanazawa
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yamada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Oizumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriya
mesh_terms: D001980:Bronchi / Q000473:pathology*; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000295:instrumentation* / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface