Diagnosing a solitary pulmonary nodule using multiple bronchoscopic guided technologies: A prospective randomized study

Liyan Bo; Congcong Li; Lei Pan; Hongwu Wang; Shiyue Li; Qiang Li; Chong Bai; Yiming Zeng; Yandong Nan; Yan Wang; Haidong Huang; Rui Zhou; Hongmei Zhou; Wen Liu; Jiayuan Sun; Zhiguang Liu; Faguang Jin

doi:10.1016/j.lungcan.2019.01.006

Diagnosing a solitary pulmonary nodule using multiple bronchoscopic guided technologies: A prospective randomized study

Lung Cancer. 2019 Mar:129:48-54. doi: 10.1016/j.lungcan.2019.01.006. Epub 2019 Jan 16.

Authors

Liyan Bo¹, Congcong Li², Lei Pan¹, Hongwu Wang³, Shiyue Li⁴, Qiang Li⁵, Chong Bai⁵, Yiming Zeng⁶, Yandong Nan¹, Yan Wang¹, Haidong Huang⁵, Rui Zhou⁷, Hongmei Zhou⁸, Wen Liu⁸, Jiayuan Sun⁹, Zhiguang Liu¹⁰, Faguang Jin¹¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China.
² Department of Respiratory and Critical Care Medicine, General Hospital of Northern Theater, Shenyang, PR China.
³ Department of Respiratory Medicine, Meitan General Hospital, Beijing, PR China.
⁴ Gungzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China.
⁵ Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai, 200080, PR China.
⁶ Department of Respiratory Pulmonary and Critical Care Medicine, The Second Hospital of Fujian Medical University, Quanzhou, Fujian Province, PR China.
⁷ Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, PR China.
⁸ Department of Respiratory Medicine, The Second Hospital of Gansu Province, Lanzhou, Gansu, PR China.
⁹ Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Shanghai, 200080, PR China.
¹⁰ Department of Respiratory Medicine, Hunan People's Hospital, Changsha, Hunan, PR China.
¹¹ Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, PR China. Electronic address: jinfag@fmmu.edu.cn.

PMID: 30797491
DOI: 10.1016/j.lungcan.2019.01.006

Abstract

Background: The rate of detection of pulmonary nodules on computed radiography (CR) is approximately 0.09-0.2%, so rapid identification of the nature of solitary pulmonary nodules (SPNs) with a likelihood of malignancy is a critical challenge in the early diagnosis of lung cancer.

Objective: We conducted this study to compare the diagnostic yield and safety of endobronchial ultrasonography with a guide sheath (EBUS-GS), and the combination of EBUS-GS and virtual bronchoscopic navigation (VBN).

Methods: This was a prospective, multicenter, multi-arm, randomized controlled trial involving a total of 1010 subjects. All the patients recruited underwent a chest CT scan which found SPNs that needed to be diagnosed. The subjects were randomly divided into one of three groups: a traditional, non-guided, bronchoscopy biopsy group (NGB group), an EBUS-GS guided bronchoscopy biopsy group (EBUS group), and a guided bronchoscopy biopsy group that combined EBUS-GS with VBN (combined group). The primary endpoint was to investigate the differences between the diagnostic yields of the three groups.

Results: There was no significant difference in the diagnostic yield between the EBUS group (72.3%) and the combined group (74.3%), but the diagnostic yield for the NGB group was 41.2%. The time required to reach biopsy position was significantly less in the combined group (7.96 ± 1.18 min in the combined group versus 11.92 ± 5.37 min in the EBUS group, p < 0.05). However, the bronchoscope operation time was the same in the EBUS-GS and combined groups. The diagnostic yield for peripheral pulmonary lesions (PPLs) >20 mm in diameter was significantly higher than for those <20 mm in diameter.

Conclusion: The results of our study suggest that guided bronchoscopy could increase the diagnostic yield in the context of peripheral lesions. There was no significant difference in the diagnostic yield between the EBUS and combined groups, but use of EBUS-GS with VBN could significantly shorten the bronchoscope arrival time.

Keywords: Bronchoscope; EBUS-GS; Lung neoplasms; Solitary pulmonary nodule; VBN.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Bronchoscopy / methods*
Carcinoma, Bronchogenic / diagnosis*
Early Diagnosis
Female
Humans
Lung Neoplasms / diagnosis*
Male
Middle Aged
Multiple Pulmonary Nodules / diagnosis*
Prospective Studies
Solitary Pulmonary Nodule / diagnosis*
Young Adult