Safety and factors affecting diagnostic yield in modified virtual bronchoscopy-guided transparenchymal nodule access for pulmonary lesions.

BACKGROUND

With the advent of low-dose computed tomography (CT) screening, minimally invasive evaluation of pulmonary lesions has become increasingly important. This study aimed to assess factors influencing the diagnostic yield of novel bronchoscopic transparenchymal nodule access (BTPNA) method for diagnosing pulmonary lesions in a real-world clinical setting.

METHODS

This retrospective study evaluated patients who underwent BTPNA with or without real-time image guidance for pulmonary lesion assessment. Lesions were deemed inaccessible if a diagnosis could not be obtained via CT-guided transthoracic biopsy or conventional bronchoscopy. CT images for each patient were used to reconstruct a navigation map and design a point of entry (POE) along the airway wall through the lung parenchyma to the lesion. Patients were monitored for more than 48 h after BTPNA.

RESULTS

Between January 2022 and July 2024, 17 patients underwent BTPNA without adverse events requiring immediate treatment during the procedures. Adequate biopsies were obtained from 15 patients for whom a tunnel path was created. The overall diagnostic yield was 77%, influenced by nodule size, CT morphology, and the chosen path. Real-time guidance during BTPNA and airway diameter at the POE did not significantly affect the diagnostic yield in this analysis.

CONCLUSION

BTPNA has shown potential as a high-yield and safe diagnostic technique for patients in whom alternative methods were considered unsuitable due to safety concerns or low expected diagnostic yield.