Cone-beam computed tomography-guided endobronchial ultrasound using an ultrathin bronchoscope for diagnosis of peripheral pulmonary lesions: a prospective pilot study

Naoya Kawakita; Hiroaki Toba; Shinichi Sakamoto; Naoki Miyamoto; Mika Takashima; Yukikiyo Kawakami; Kazuya Kondo; Hiromitsu Takizawa

doi:10.21037/jtd-22-1369

Cone-beam computed tomography-guided endobronchial ultrasound using an ultrathin bronchoscope for diagnosis of peripheral pulmonary lesions: a prospective pilot study

J Thorac Dis. 2023 Feb 28;15(2):579-588. doi: 10.21037/jtd-22-1369. Epub 2023 Feb 8.

Authors

Naoya Kawakita¹, Hiroaki Toba¹, Shinichi Sakamoto¹, Naoki Miyamoto¹, Mika Takashima¹, Yukikiyo Kawakami¹, Kazuya Kondo², Hiromitsu Takizawa¹

Affiliations

¹ Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, The University of Tokushima Graduate School, Tokushima, Japan.
² Department of Oncological Medical Services, Graduate School of Biomedical Biosciences, Tokushima University, Tokushima, Japan.

Abstract

Background: Multimodal transbronchial biopsy (TBB) may have improved diagnostic yield for peripheral pulmonary lesions suspected as lung cancer. Radial endobronchial ultrasound (R-EBUS) provides real-time imaging and confirmation of the location of the lesions. Cone-beam computed tomography (CBCT) can confirm that the forceps tip has reached the lesion before biopsy.

Methods: Patients with peripheral pulmonary lesions and a positive computed tomography (CT) bronchus sign (based on slice thickness of 1 mm) were prospectively enrolled. An ultrathin bronchoscope (UTB) and R-EBUS probe were advanced to the target bronchus. Thereafter, forceps were advanced, and CBCT was performed. R-EBUS was performed for re-navigation, if possible. The obtained EBUS and CBCT images were classified into "within" (type 1), "adjacent to" (type 2), or "far from" (type 3), based on the probe or forceps tip.

Results: For 20 lesions, the diagnostic yield was 85%. The primary EBUS images were of types 1, 2, and 3 in 12, 6, and 2 cases, respectively. The primary CBCT images were of types 1, 2, and 3 in 12, 6, and 2 cases, respectively. Primary EBUS and CBCT image types were equivalent in 14 cases. Of the 12 cases with type 1 primary EBUS image, 9 cases had a type 1 primary CBCT image, while 3 cases exhibited positional misalignment of the forceps tip. Re-navigation was required in 8 cases with types 2 and 3 primary CBCT images.

Conclusions: CBCT-guided TBB using an UTB and EBUS may enable real-time positioning guidance and better re-navigation in the diagnosis of peripheral pulmonary lesions.

Keywords: Cone-beam computed tomography (CBCT); endobronchial ultrasound (EBUS); transbronchial lung biopsy; ultrathin bronchoscope (UTB); virtual bronchoscopic navigation (VBN).