Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu 500-8717, Japan.
Thorax. 2011 Dec;66(12):1072-7. doi: 10.1136/thx.2010.145490. Epub 2011 Jul 11.
Bronchoscopy using endobronchial ultrasound (EBUS) can help to diagnose small peripheral pulmonary lesions. However, although biopsy sites can be confirmed, a bronchoscope cannot be guided in EBUS. Virtual bronchoscopic navigation (VBN) can guide a bronchoscope with virtual images, but its value has not been confirmed.
This prospective multicentre study examines the value of VBN-assisted EBUS for diagnosing small peripheral pulmonary lesions. 199 patients with small peripheral pulmonary lesions (diameter ≤30 mm) were randomly assigned to VBN-assisted (VBNA) or non-VBN-assisted (NVBNA) groups. A bronchoscope was introduced into the target bronchus of the VBNA group using the VBN system. Sites of specimen sampling were verified using EBUS with a guide sheath under fluoroscopy.
The diagnostic yield was higher for the VBNA than for the NVBNA group (80.4% vs 67.0%; p = 0.032). The duration of the examination and time elapsed until the start of sample collection were reduced in the VBNA compared with the NVBNA group (median (range), 24.0 (8.7-47.0) vs 26.2 (11.6-58.6) min, p = 0.016) and 8.1 (2.8-39.2) vs 9.8 (2.3-42.3) min, p = 0.045, respectively). The only adverse event was mild pneumothorax in a patient from the NVBNA group.
The diagnostic yield for small peripheral pulmonary lesions is increased when VBN is combined with EBUS. Clinical trial number UMIN000000569.
支气管内超声（EBUS）引导下经支气管镜活检术可用于诊断外周肺小结节。但由于支气管镜不能被引导至活检部位，因此需要虚拟支气管镜导航（VBN）引导。虚拟支气管镜导航可引导支气管镜，但目前其应用价值尚未得到证实。
本前瞻性多中心研究旨在评估 VBN 辅助 EBUS 诊断外周肺小结节的价值。199 例直径≤30mm 的外周肺小结节患者被随机分为 VBN 辅助组（VBNA）和非 VBN 辅助组（NVBNA）。VBNA 组使用 VBN 系统将支气管镜引入目标支气管，在透视下使用引导鞘进行 EBUS 以验证标本取样部位。
VBNA 组的诊断检出率高于 NVBNA 组（80.4% vs. 67.0%；p=0.032）。与 NVBNA 组相比，VBNA 组的检查时间和标本采集开始时间更短（中位数（范围）：24.0（8.7-47.0）vs. 26.2（11.6-58.6）min，p=0.016；8.1（2.8-39.2）vs. 9.8（2.3-42.3）min，p=0.045）。唯一的不良事件是 NVBNA 组的 1 例患者发生轻度气胸。
VBN 联合 EBUS 可提高外周肺小结节的诊断检出率。临床试验注册号 UMIN000000569。
