Virtual bronchoscopic navigation combined with ultrathin bronchoscopy. A randomized clinical trial

Area of Science:

• Pulmonology
• Medical Imaging
• Interventional Bronchoscopy

Background:

• Ultrathin bronchoscopes enable access to peripheral bronchi.
• Virtual bronchoscopic navigation (VBN) aids bronchoscope guidance using virtual images.
• Combining VBN with ultrathin bronchoscopy may enhance peripheral lesion diagnosis.

Purpose of the Study:

• To evaluate the diagnostic value of VBN-assisted ultrathin bronchoscopy for peripheral pulmonary lesions.
• To compare diagnostic yield between VBN-assisted and non-VBN-assisted ultrathin bronchoscopy.

Main Methods:

• Prospective multicenter study of 334 patients with peripheral pulmonary lesions (≤30 mm).
• Randomized assignment to VBN-assisted or non-VBN-assisted ultrathin bronchoscopy groups.
• VBN group used navigation system; control group used CT images; X-ray fluoroscopy verified sampling sites.

Main Results:

• No significant difference in overall diagnostic yield between VBN-assisted (67.1%) and non-VBN-assisted (59.9%) groups.
• Significantly higher diagnostic yield for VBN-assisted group in right upper lobe lesions (81.3% vs. 53.2%).
• Improved yield for VBN-assisted group in lesions invisible on radiographs (63.2% vs. 40.5%) and in the peripheral lung third (64.7% vs. 52.1%).

Conclusions:

• VBN-assisted ultrathin bronchoscopy does not enhance overall diagnostic yield for peripheral pulmonary lesions.
• The technique shows improved diagnostic yield for specific lesion subsets.
• Further research is warranted for targeted application of VBN in specific clinical scenarios.