Diagnostic yield of cone beam CT based navigation bronchoscopy in patients with metastatic lesions: A propensity score matched case-control study.

BACKGROUND

Cone beam CT based Navigation Bronchoscopy (CBCT-NB) has predominantly been investigated as a diagnostic tool in (suspected) primary lung cancers. Small metastatic lesions are clinically considered more challenging to diagnose, but no study has explored the yield of navigation bronchoscopy in patients with pulmonary metastatic lesions (ML) compared to primary lung cancers (PL), correcting for known lesion characteristics affecting diagnostic yield.

MATERIALS AND METHODS

This is a single-center, retrospective, propensity score-matched case-control study. We matched a subset of patients who underwent CBCT-NB and received a final diagnosis of pulmonary metastases of solid tumors between December 2017 and 2021 against confirmed primary lung cancer lesions subjected to CBCT-NB in the same time period. The lesions were propensity score matched based on known characteristics affecting yield, including location (upper lobe, lower lobe), size, bronchus sign, and lesion solidity.

RESULTS

Fifty-six metastatic pulmonary lesions (mean size 14.7 mm) were individually case-matched to a selection of 297 available primary lung cancer lesions. Case-matching revealed non-significant differences in navigation success rate (PL: 89.3 % vs. ML: 82.1 %, 95%CI on differences: -21.8 to +7.5) and yield (PL: 60.7 % vs. ML: 55.4 %, 95%CI on differences: -25.4 to +14.7). The overall complication rate was comparable (5.4 % in PL vs. 5,4 % in ML).

CONCLUSION

After matching primary and metastatic lesions based on CT assessable lesions characteristics, CBCT-NB showed no clinically relevant or significantly different navigation success or yield in either group. We recommend a careful assessment of CT characteristics to determine procedural difficulty rather than selecting based on the suspicion of lesion origin.

Informations de copyright

© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Déclaration de conflit d'intérêts

Declaration of competing interest Marta Viscuso (MV), Rocco Trisolini (RT), and Gerjon Hannink (GH) declare no conflict of interest. S.E.P. Kops: declares no conflicts of interest in relation to the content or conceptualization of this work. Author received no personal fees. All fees were received by the department. Johnson & Johnson: consultancy fees; WABIP regent (unpaid function). R.L.J. Verhoeven: declares no conflicts of interest in relation to the content or conceptualization of this work. Author received no personal fees, but discloses institutional and departmental research contracts with Pentax medical, AstraZeneca, Johnson & Johnson, Philips, Intuitive, Innovative Health Initiative (EU fund), KWF (national cancer fund), as well as consulting fees from Intuitive, Johnson & Johnson, NLC paid to the institution, travel support from Intuitive and Johnson & Johnson, equipment gifts from Philips Medical, and a current board membership at the Dutch society for Technical Physicians (NVvTG, unpaid). E. HFM. Van der Heijden declares no conflicts of interest in relation to the content or conceptualization of this work. Author received no personal fees but discloses institutional research grants from Pentax medical, AstraZeneca, Johnson & Johnson, Philips, Intuitive, Innovative Health Initiative (EU fund), KWF (national cancer fund), as well as consulting fees from Intuitive, Johnson & Johnson, NLC paid to the institution, travel support from Intuitive and Johnson & Johnson; speaker fees paid to institution by Janssen-Cilag, Pentax, Philips, Astra Zeneca, Intuitive, Siemens and Ethicon; equipment gifts from Philips Medical and equipment loans from Pentax Medical and Intuitive, and a current board membership at the European Association for Bronchology and Interventional Pulmonology (unpaid).