TY  - JOUR
AU  - Marta Diez-Ferrer
AU  - Arturo Morales
AU  - Rosa Lopez Lisbona
AU  - Noelia Cubero
AU  - Cristian Tebe
AU  - Susana Padrones
AU  - Samantha Aso
AU  - Jordi Dorca
AU  - Debora Gil
AU  - Antoni Rosell
PY  - 2019//
TI  - Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield
T2  - RES
JO  - Respiration
SP  - 252
EP  - 258
VL  - 97
IS  - 3
KW  - Lung cancer
KW  - Peripheral lung lesion
KW  - Diagnosis
KW  - Bronchoscopy
KW  - Ultrathin bronchoscopy
KW  - Virtual bronchoscopic navigation
N2  - Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources.
UR  - https://doi.org/10.1159/000493270
N1  - IAM; 600.145; 600.139
ID  - Marta Diez-Ferrer2019
ER  -