title: Combination of virtual bronchoscopic navigation with conventional transbronchial needle aspiration in the diagnosis of peribronchial pulmonary lesions located in the middle third of the lungs.
abstract: BACKGROUND
  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is frequently applied to the diagnosis of central airway lesions, and endobronchial ultrasound with a guide sheath (EBUS-GS) is mainly used for the diagnosis of peripheral pulmonary lesions. However, there remains an unmet need to improve the diagnostic yields for peribronchial pulmonary lesions located along the secondary/tertiary and fourth/fifth bronchi (the "middle third zone" of the lungs), which neither EBUS-TBNA nor EBUS-GS can easily approach.
  
  
  METHODS
  A combination of virtual bronchoscopic navigation (VBN) with conventional TBNA was utilized for the cytological diagnosis of 15 patients with small pulmonary lesions (less than 20mm in diameter) in the middle third zone between March 2012 and January 2015 in our respiratory institute. The lesions were traced using the VBN system, and then the VBN was operated and guided by the vision of actual bronchoscopy. The TBNA site was determined by VBN, and the specimens were obtained using conventional TBNA under X-ray fluoroscopy. The diagnosis was made based on the cytological findings of the specimens.
  
  
  RESULTS
  Adequate specimens were obtained in 12 (80.0%) of the cases through the novel technique of combining TBNA with VBN in bronchoscopic examinations. Seven out of the ten malignant cases (70.0%) were definitely diagnosed by this procedure. No adverse effects were experienced, except for an acceptable amount of bleeding.
  
  
  CONCLUSIONS
  The combination of VBN with conventional TBNA was advantageous and safe for the cytological diagnosis of small peribronchial pulmonary lesions in the middle third zone of the lungs.
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: yasumasa@shinshu-u.ac.jp.
authors: Masanori
authors: M
authors: Yasuo
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: takob@shinshu-u.ac.jp.
authors: Takashi
authors: T
authors: Kobayashi
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: mineyuki@shinshu-u.ac.jp.
authors: Mineyuki
authors: M
authors: Hama
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: ichiyama@shinshu-u.ac.jp.
authors: Takashi
authors: T
authors: Ichiyama
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: toshih@shinshu-u.ac.jp.
authors: Toshimichi
authors: T
authors: Horiuchi
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: yama5252@shinshu-u.ac.jp.
authors: Hiroshi
authors: H
authors: Yamamoto
authors: Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: kawasato@shinshu-u.ac.jp.
authors: Satoshi
authors: S
authors: Kawakami
authors: The Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: kham@shinshu-u.ac.jp.
authors: Kazutoshi
authors: K
authors: Hamanaka
authors: Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: thondat@shinshu-u.ac.jp.
authors: Takayuki
authors: T
authors: Honda
authors: The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. Electronic address: masayuki@shinshu-u.ac.jp.
authors: Masayuki
authors: M
authors: Hanaoka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D001980:Bronchi; D001984:Bronchial Neoplasms / Q000473:pathology; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014584:User-Computer Interface
keywords: Bronchoscopy; Peribronchial pulmonary lesions; Transbronchial needle aspiration; Virtual bronchoscopic navigation