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Lung Cancer (Amsterdam, Netherlands) Jun 2023Navigation bronchoscopy has seen rapid development in the past decade in terms of new navigation techniques and multi-modality approaches utilizing different techniques... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Navigation bronchoscopy has seen rapid development in the past decade in terms of new navigation techniques and multi-modality approaches utilizing different techniques and tools. This systematic review analyses the diagnostic yield and safety of navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules suspected of lung cancer.
METHODS
An extensive search was performed in Embase, Medline and Cochrane CENTRAL in May 2022. Eligible studies used cone-beam CT-guided navigation (CBCT), electromagnetic navigation (EMN), robotic navigation (RB) or virtual bronchoscopy (VB) as the primary navigation technique. Primary outcomes were diagnostic yield and adverse events. Quality of studies was assessed using QUADAS-2. Random effects meta-analysis was performed, with subgroup analyses for different navigation techniques, newer versus older techniques, nodule size, publication year, and strictness of diagnostic yield definition. Explorative analyses of subgroups reported by studies was performed for nodule size and bronchus sign.
RESULTS
A total of 95 studies (n = 10,381 patients; n = 10,682 nodules) were included. The majority (n = 63; 66.3%) had high risk of bias or applicability concerns in at least one QUADAS-2 domain. Summary diagnostic yield was 70.9% (95%-CI 68.4%-73.2%). Overall pneumothorax rate was 2.5%. Newer navigation techniques using advanced imaging and/or robotics(CBCT, RB, tomosynthesis guided EMN; n = 24 studies) had a statistically significant higher diagnostic yield compared to longer established techniques (EMN, VB; n = 82 studies): 77.5% (95%-CI 74.7%-80.1%) vs 68.8% (95%-CI 65.9%-71.6%) (p < 0.001).Explorative subgroup analyses showed that larger nodule size and bronchus sign presence were associated with a statistically significant higher diagnostic yield. Other subgroup analyses showed no significant differences.
CONCLUSION
Navigation bronchoscopy is a safe procedure, with the potential for high diagnostic yield, in particular using newer techniques such as RB, CBCT and tomosynthesis-guided EMN. Studies showed a large amount of heterogeneity, making comparisons difficult. Standardized definitions for outcomes with relevant clinical context will improve future comparability.
Topics: Humans; Bronchoscopy; Lung Neoplasms; Solitary Pulmonary Nodule; Bronchi; Cone-Beam Computed Tomography
PubMed: 37130440
DOI: 10.1016/j.lungcan.2023.107196 -
Panminerva Medica Sep 2019We describe the current knowledge and skills for the main techniques of operative bronchoscopy and their applications in the treatment of malignant and benign central... (Review)
Review
We describe the current knowledge and skills for the main techniques of operative bronchoscopy and their applications in the treatment of malignant and benign central airway disorders. Rigid bronchoscopy has a history of over 100 years. The use of rigid bronchoscopy was abandoned upon the introduction of the fiberoptic bronchoscope but has made a reappearance with the development of interventional pulmonology in the late nineteenth and early twentieth century. The advantages of rigid bronchoscopy include allowing simultaneous procedures, such as ablation, debulking and suctioning, without limiting ventilation but at the moment there are no standard approaches to perform the procedure. Rigid bronchoscopy also plays a vital role in stent placement, repositioning, maintenance and removal. An interventional pulmonology practice should only be developed when there is a locoregional unmet medical need and when a dedicated interventional pulmonology unit can be guaranteed. These departments should be available 7 days a week and should provide a fast and appropriate response to referrals in emergency cases. There is a clear need to define a competency-based training program for rigid bronchoscopy, including stent placement. An optimal, multimodality training program for bronchoscopy should include didactic lectures, web-based learning, case-based reviews and hands-on training.
Topics: Bronchoscopes; Bronchoscopy; Clinical Competence; Constriction, Pathologic; Fiber Optic Technology; Humans; Lung; Lung Diseases; Pulmonary Medicine; Stents; Trachea
PubMed: 31364332
DOI: 10.23736/S0031-0808.19.03602-4 -
Therapeutic Advances in Respiratory... 2023Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are... (Review)
Review
Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are typically the main contributors to patient mortality because of the improper contact between the bronchial and pleural cavity. Therefore, bronchopleural fistulas need immediate treatment, which requires the accurate location and timely closure of the fistula. Currently, bronchoscopic interventions, because of their flexibility and versatility, are reliable alternative therapies in patients for whom surgical intervention is unsuitable. Possible interventions include bronchoscopic placement of blocking agents, atrial septal defect (ASD)/ventricular septal defect (VSD) occluders, airway stents, endobronchial valves (EBVs) and endobronchial Watanabe spigots (EWSs). Recent developments in mesenchymal stem cells (MSCs) transplantation technology and three-dimensional (3D) printed stents have also contributed to the treatment of bronchopleural fistula, but more research is needed to investigate the long-term benefits. This review focuses on the effectiveness of various bronchoscopic measures for the treatment of bronchopleural fistula and the directions for future development.
Topics: Humans; Bronchoscopy; Postoperative Complications; Pleural Diseases; Bronchial Fistula; Pneumonia; Pneumonectomy
PubMed: 37067054
DOI: 10.1177/17534666231164541 -
IEEE Transactions on Bio-medical... Dec 2015Bronchoscopy is a commonly used minimally invasive procedure for lung-cancer staging. In standard practice, however, physicians differ greatly in their levels of...
Bronchoscopy is a commonly used minimally invasive procedure for lung-cancer staging. In standard practice, however, physicians differ greatly in their levels of performance. To address this concern, image-guided intervention (IGI) systems have been devised to improve procedure success. Current IGI bronchoscopy systems based on virtual bronchoscopic navigation (VBN), however, require involvement from the attending technician. This lessens physician control and hinders the overall acceptance of such systems. We propose a hands-free VBN system for planning and guiding bronchoscopy. The system introduces two major contributions. First, it incorporates a new procedure-planning method that automatically computes airway navigation plans conforming to the physician's bronchoscopy training and manual dexterity. Second, it incorporates a guidance strategy for bronchoscope navigation that enables user-friendly system control via a foot switch, coupled with a novel position-verification mechanism. Phantom studies verified that the system enables smooth operation under physician control, while also enabling faster navigation than an existing technician-assisted VBN system. In a clinical human study, we noted a 97% bronchoscopy navigation success rate, in line with existing VBN systems, and a mean guidance time per diagnostic site = 52 s. This represents a guidance time often nearly 3 min faster per diagnostic site than guidance times reported for other technician-assisted VBN systems. Finally, an ergonomic study further asserts the system's acceptability to the physician and long-term potential.
Topics: Aged; Bronchoscopes; Bronchoscopy; Equipment Design; Female; Humans; Lung Neoplasms; Male; Middle Aged; Phantoms, Imaging; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 25675452
DOI: 10.1109/TBME.2015.2401514 -
Panminerva Medica Sep 2019Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a... (Review)
Review
Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a device called Alair™ Catheter (Boston Scientific, Natick, MA, USA). The Alair™ system is the first device that works by delivering radiofrequency or thermal energy to selectively reduce the amount of airway smooth muscle (ASM) in bronchi. Literature showed significant improvement in clinical outcomes such as symptom control, severe exacerbation rate, hospitalization, quality of life, and number of working or school days lost for asthma. Besides smooth muscle effects changes in inflammatory pattern after BT have been documented. Bronchial thermoplasty requires an experienced physician who had a proficiency training in bronchoscopy and had rigor, dexterity and a thorough knowledge of the airway anatomy. Furthermore, right selection of severe asthma patient is crucial in order to have best response after BT. This article reviews BT device description and how to perform the procedure. Criteria for right selection and management of patient before and after BT will be discussed.
Topics: Asthma; Bronchi; Bronchial Thermoplasty; Bronchoscopes; Bronchoscopy; Clinical Competence; Humans; Pulmonary Medicine; Radio Waves
PubMed: 30486619
DOI: 10.23736/S0031-0808.18.03582-6 -
Respiratory Medicine Oct 2009The efficacy and technical aspects of endobronchial ultrasound (EBUS) are reviewed because this technology promises to revolutionise bronchoscopy. EBUS extends the... (Review)
Review
The efficacy and technical aspects of endobronchial ultrasound (EBUS) are reviewed because this technology promises to revolutionise bronchoscopy. EBUS extends the endoscopist's view beyond the mucosal surface of the large airways to peri-bronchial structures and peripheral lung lesions. Guided biopsies and real-time transbronchial needle aspirations (TBNA) have been shown to increase the diagnostic yield over conventional bronchoscopic techniques. The technology is available in two forms: radial EBUS probes and linear EBUS-TBNA bronchoscopes. Radial EBUS utilizes higher frequencies and the transducer is inserted via a standard flexible bronchoscope. The higher ultrasound frequencies improve image resolution to <1mm. Radial EBUS is used to assess airway walls, guide TBNA (diagnostic yield: 72-86%) and diagnose peripheral lung lesions (diagnostic yield: 61-80%). Linear EBUS-TBNA transducers are built into dedicated bronchoscopes to produce sector view images and permit real-time TBNA. The pooled sensitivity of real-time EBUS-TBNA in lung cancer is 90% but the false negative rate is 20%. Therefore, EBUS-TBNA is a viable alternative to cervical mediastinoscopy in the diagnosis and staging of mediastinal lymphadenopathy. However, negative results need either further confirmatory testing or adequate clinical follow-up. Complications are rare with either EBUS modality and are usually related to the underlying biopsy procedure rather than the use of ultrasound. Procedure duration is short enough to be incorporated into an outpatient setting and can performed under moderate sedation. Clear training standards are emerging to facilitate credentialing as EBUS is rapidly evolving to become a part of standard diagnostic bronchoscopy.
Topics: Bronchoscopes; Bronchoscopy; Clinical Competence; Humans; Lung Diseases; Lymph Nodes; Lymphatic Diseases; Ultrasonography, Interventional
PubMed: 19447014
DOI: 10.1016/j.rmed.2009.04.010 -
F1000Research 2018Bronchoscopy is a very common tool for diagnosis and therapeutic purposes in dealing with diseases of the lungs and the airways. Thankfully, a multitude of new... (Review)
Review
Bronchoscopy is a very common tool for diagnosis and therapeutic purposes in dealing with diseases of the lungs and the airways. Thankfully, a multitude of new technologies have made it more accessible for the use of physicians. This article is a review of the indication of bronchoscopy as it is being used today for a variety of chest pathologies.
Topics: Bronchoscopy; Humans; Lung Diseases; Pulmonary Medicine; Respiratory Tract Diseases
PubMed: 30364219
DOI: 10.12688/f1000research.14596.1 -
Tuberkuloz Ve Toraks 2011Flexible bronchoscopy is usually performed at a tertiary care facility in a general endoscopy unit or a specially designed bronchoscopy suite. The procedure can also be... (Review)
Review
Flexible bronchoscopy is usually performed at a tertiary care facility in a general endoscopy unit or a specially designed bronchoscopy suite. The procedure can also be performed outside the designated facility if the qualified personnel and required equipment can be mobilized. In this review, we discuss the essentials of a modern bronchoscopy suite based on the available information from the literature.
Topics: Bronchoscopy; Diagnostic Services; Facility Design and Construction; Humans; Lung Diseases
PubMed: 22087526
DOI: 10.5578/tt.2420 -
Respiratory Care Feb 2022Bronchoscopy is an aerosol-generating procedure and routine use for patients with coronavirus disease 2019 (COVID-19) has been discouraged. The purpose of this review... (Review)
Review
BACKGROUND
Bronchoscopy is an aerosol-generating procedure and routine use for patients with coronavirus disease 2019 (COVID-19) has been discouraged. The purpose of this review was to discuss the indications, clinical utility, and risks associated with bronchoscopy in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
METHODS
A literature search was performed by using appropriate key terms to identify all relevant articles from medical literature databases up to August 1, 2021.
RESULTS
Twelve cohorts (9 retrospective and 3 prospective) reported the performance of 2,245 bronchoscopies in 1,345 patients with COVID-19. The majority of the subjects were male. Nearly two thirds of the bronchoscopies (62%) were performed for therapeutic indications; the rest (38%) were for diagnostic purposes. Bronchoalveolar lavage had an overall yield of 33.1% for SARS-CoV-2 in subjects with negative results of real-time polymerase chain reaction on nasopharyngeal specimens. The incidence of a secondary infection ranged from 9.3% to as high as 65%. Antibiotics were changed in a significant number of the subjects (14%-83%) based on the bronchoscopic findings. Bronchoscopy was well tolerated in most subjects except those who required noninvasive ventilation, in whom the intubation rate after the procedure was 60%. The rate of transmission of SARS-CoV-2 among health-care workers was minimum.
CONCLUSIONS
Bronchoscopy in patients with COVID-19 results in a significant change in patient management. Transmission of SARS-CoV-2 seems to be low with consistent use of appropriate personal protective equipment by health-care workers. Therefore, bronchoscopic evaluation should be considered for all diagnostic and therapeutic indications in this patient population.
Topics: Bronchoscopy; COVID-19; Female; Humans; Male; Prospective Studies; Retrospective Studies; SARS-CoV-2
PubMed: 34848547
DOI: 10.4187/respcare.09405 -
European Respiratory Review : An... Jun 2013Flexible bronchoscopy is commonly performed by respiratory physicians and is the gold standard for directly visualising the airways, allowing for numerous diagnostic and... (Review)
Review
Flexible bronchoscopy is commonly performed by respiratory physicians and is the gold standard for directly visualising the airways, allowing for numerous diagnostic and therapeutic interventions. With the widespread use of flexible bronchoscopy and the evolution of interventional bronchoscopy with more complex and longer procedures, physicians are placing increasing importance on the use of sedation as a necessary adjunct to topical anaesthesia. There is no standardised practice for the use of sedation in bronchoscopy with a good deal of variation among physicians regarding the use of pre-procedure medication and pharmacological sedatives. In addition, there is ongoing debate and controversy about proceduralist-administered versus anaesthetist-administered sedation whilst at the same time there is a growing body of evidence that nonanaesthetist administered sedation is safe and cost-effective. In this review we summarise the evidence for the use of sedation as an adjunct to topical anaesthesia in bronchoscopy and provide the clinician with up-to-date concise guidance for the use of pharmacological sedatives in bronchoscopy and future directions for sedation in the bronchoscopy suite.
Topics: Bronchoscopy; Clinical Competence; Conscious Sedation; Deep Sedation; Humans; Hypnotics and Sedatives; Practice Guidelines as Topic; Premedication
PubMed: 23728864
DOI: 10.1183/09059180.00006412