Page 54 - ECBIP 2021_Program
P. 54

6th European Congress ECBIP 15 - 17
  Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
 MODERATED e-POSTER SESSION 03:
EBUS Bronchoscopy
        VIRTUAL BRONCHOSCOPY PREDICTORS FOR SUCCESSFUL RADIAL EBUS-GUIDED TRANSBRONCHIAL BIOPSY OF PERIPHERAL LUNG LESIONS
Philip Emmanouil1, Vlasios Vitsas1, Nektarios Anagnostopoulos2, Grigorios Stratakos2
1 Interventional Pulmonology Unit, Mediterraneo Hospital, Athens, Greece
2 Interventional Pulmonology Unit, 1st Department of Pulmonary Medicine, Sotiria General hospital, National and Kapodistrian University of Athens, Athens, Greece
      PP20
   Diagnosis of small peripheral lung lesions represents a major challenge. One of the most commonly used modalities is the radial EBUS combined with fluoroscopic guidance.Virtual bronchoscopy navigation (VBN) can assist localizing the lesions by creating a 3D representation of the bronchi suggesting an ideal route to introduce the radial EBUS and ensure adequate transbronchial biopsies.
Aim: We have examined the predictive value of certain parameters provided by the VBN system for successful transbronchial biopsy. Additionally, a prediction score is proposed.
Methods: Patients with peripheral lung lesions that underwent bronchoscopy under general sedation or neuroleptoanalgesia were recruited prospectively.The targeted bronchus was selected by the VBN system by creating a virtual endobronchial route. Subsequently, radial EBUS was introduced and the probe’s position was confirmed by fluoroscopy. The following predictive VBN parameters were recorded: Presence of bronchus sign to the lesion (BS), diameter of sub-segemental bronchus (Diameter) leading to the lesion and distance of the closest bronchus from the lesion (Distance).
Results: 48 patients (31 men) underwent bronchoscopy for peripheral lung lesions. Median lesion diameter was 25.4 mm (SD 9.5mm). The lesions were distributed as follows: Right upper lobe (16), right middle lobe (3), right lower lobe (9), left upper lobe (13), left lower lobe (7). Diagnosis of malignancy was set in 28 patients (58%). Adenocarcinoma in 43.8%, Squamous cell carcinoma in 12.5% and Small Cell Carcinoma in 2.1%. Twenty patients underwent further surgical diagnostic procedures. The presence of BS and the Distance showed a significant correlation with successful transbronchial biopsy [p <0,001 for BS and 0,002 for distance 2.1mm (1.3─4.2), respectively]. The optimal distance point was 5.83 mm, achieving an AUC of 0.76, sensitivity 82.1% and specificity 75%. AUC, sensitivity, specificity and positive likelihood ratio for presence of BS was 0.91, 85%, 95%, and 6.4 respectively. A grading system was proposed, where distance <=5.83 was given a score of -2 and the presence of BS score +3. For lesions attaining a score of ≥1, sensitivity for transbronchial diagnosis was 96.4% and specificity 85%. AUC was 0.93 (95% CI: 0.85-1.00; p<0.001).
Conclusions: VBN constitutes a significant additional tool to radial EBUS and fluoroscopic guidance for peripheral pulmonary lesions.A score comprised of BS sign and distance from nearest to the lesion bronchus can predict successful transbronchial biopsy. A prediction score of≥1 achieved more than 96% sensitivity.
54 6th European Congress for Bronchology and Interventional Pulmonology
  
















































































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