When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Human Ethics Approval Declaration
2.3. Operators
2.4. Procedures
2.5. Diagnosis and Definition of Diagnostic Yield
- Samples with malignant cells at cytopathological evaluation.
- Samples showing a specific benign diagnosis including either infection, granulomas or cryptogenic organized pneumonia at cytopathological and/or microbiological evaluation.
- Samples without a specific benign diagnosis and without malignant cells in examples samples with mild inflammation AND (for all cases) at least one subsequent CT-scan after at least 6 months with evidence of regression of the lesion.
- Samples without a specific benign diagnosis and without malignant cells with no follow-up registration, for example, if patients had died or did not wish to attend clinical follow-up.
- Samples that are deemed inadequate at cytopathological evaluation.
- Samples without a specific benign diagnosis and without malignant cells where a CT-scan or a chest X-ray during the following six months show growth of the lesion.
- Samples without a specific benign diagnosis and without malignant cells where subsequent invasive procedures such as CT-guided biopsy or EBUS return with either a malignant or a specific benign diagnosis.
- All procedures where the final diagnosis was not based on a sample obtained by the use of ENB, but based on one or more samples obtained in relation to the ENB procedure using other equipment, such as rEBUS or conventional endobronchial biopsy under direct vision.
2.6. Definition of Complications
2.7. Statistics
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Number of Procedures | 215 |
---|---|
Lesion size §, mm (mean (SD)) | 26 (12) |
Lesion location (lobe) # | |
Right upper lobe | 74 (34%) |
Right middle lobe | 13 (6%) |
Right lower lobe | 34 (16%) |
Left upper lobe | 61 (28%) |
Left lower lobe | 32 (15%) |
Lesion location (lung zone) | |
Peripheral 1/3 of the lung | 126 (59%) |
Middle 1/3 of the lung | 67 (31%) |
Central 1/3 of the lung | 22 (10%) |
Lesion visible on rEBUS §§ | |
Lesion visible on rEBUS | 154 (75%) |
Lesion not visible on rEBUS | 52 (25%) |
Lesion visibility on fluoroscopy ## | |
Lesion visible on fluoroscopy | 147 (75%) |
Lesion not visible on fluoroscopy | 50 (25%) |
Bronchus sign * present (no. (%)) | 166 (77%) |
Diagnostic Procedure N = 122 | Non-Diagnostic Procedure N = 93 | Total N = 215 | p Value | ||
---|---|---|---|---|---|
Lesion size, mm (mean (SD)) | 28 (12) | 24 (12) | 26 (12) | 0.03 | |
Lung zone (no. (% of total)) | 0.71 | ||||
Central (no.) | 14 (64%) | 8 (36%) | 22 | ||
Middle (no.) | 39 (58%) | 28 (42%) | 67 | ||
Peripheral (no.) | 69 (55%) | 57(45%) | 126 | ||
Operator (no. (% of total)) | 0.08 | ||||
Operator 1 | 43 (54%) | 36 (46%) | 79 | ||
Operator 2 | 28 (60%) | 19 (40%) | 47 | ||
Operator 3 | 42 (66%) | 22 (34%) | 64 | ||
Operator 4 | 9 (36%) | 16 (64%) | 25 | ||
Lesion visible on fluoroscopy § | 0.003 | ||||
Lesion visible on fluoroscopy | 95 (65%) | 52 (35%) | 147 | ||
Lesion not visible on fluoroscopy | 20 (40%) | 30 (60%) | 50 | ||
Lesion visible on rEBUS $ | 0.001 | ||||
Lesion visible on rEBUS | 98 (64%) | 55 (36%) | 154 | ||
Lesion not visible on rEBUS | 24 (46%) | 28 (54%) | 52 | ||
Presence of a bronchus sign * | 98 (59%) | 68 (41%) | 166 | 0.27 |
Odds Ratio for a Diagnostic Procedure * | SE | z | p | 95% CI | ||
---|---|---|---|---|---|---|
Repetition number § | 1.01 | 0.001 | 0.64 | 0.52 | 0.99 | 1.02 |
Lesion size, mm | 1.00 | 0.01 | 0.28 | 0.78 | 0.98 | 1.03 |
Lung zone | 0.61 | 0.22 | –1.37 | 0.17 | 0.31 | 1.24 |
Lesion visible on fluoroscopy | 3.10 | 1.33 | 2.64 | 0.008 | 1.34 | 7.20 |
Lesion visible on rEBUS | 1.9 | 0.83 | 1.48 | 0.14 | 0.81 | 4.50 |
Bronchus sign present # | 1.04 | 0.47 | 0.10 | 0.92 | 0.43 | 2.54 |
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Toennesen, L.L.; Vindum, H.H.; Risom, E.; Pulga, A.; Nessar, R.M.; Arshad, A.; Christophersen, A.; Park, Y.S.; Cold, K.M.; Konge, L.; et al. When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield? Diagnostics 2022, 12, 3127. https://doi.org/10.3390/diagnostics12123127
Toennesen LL, Vindum HH, Risom E, Pulga A, Nessar RM, Arshad A, Christophersen A, Park YS, Cold KM, Konge L, et al. When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield? Diagnostics. 2022; 12(12):3127. https://doi.org/10.3390/diagnostics12123127
Chicago/Turabian StyleToennesen, Louise L., Helene H. Vindum, Ellen Risom, Alexis Pulga, Rafi M. Nessar, Arman Arshad, Alice Christophersen, Yoon Soo Park, Kristoffer Mazanti Cold, Lars Konge, and et al. 2022. "When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield?" Diagnostics 12, no. 12: 3127. https://doi.org/10.3390/diagnostics12123127