Assessment of navigation bronchoscopy with rapid on-site evaluation technique in detection of peripheral lung lesions

Background
Diagnosing peripheral pulmonary lesions (PPLs) poses significant challenges due to their often-inaccessible location beyond conventional bronchoscopy reach. The integration of virtual navigation bronchoscopy (VBN) with rapid on-site evaluation (ROSE) provides a promising approach to enhance diagnostic accuracy through precise lesion localization.


Patients and methods
This prospective cohort study was conducted at Ain Shams University Hospitals from January 2022 to January 2024, involving patients with undiagnosed PPLs undergoing VBN with ROSE. Lesions were accessed with thin or adult bronchoscopes, utilizing forceps, cryoprobes, or both for biopsies, guided by C-arm fluoroscopy as needed. Immediate cytopathological feedback was provided by ROSE, with final diagnoses confirmed through histopathology, microbiology, or clinical follow-up.


Results
Of the 50 patients initially enrolled, 23 were included after excluding those with incidental endobronchial lesions. The cohort’s mean age was 56.8 years, with an average lesion size of 2.5 cm and 52.2% located in the upper lobe. Biopsies were performed using both forceps and cryoprobe in 56% of cases, and C-arm fluoroscopy was employed in 47.8% of cases. The overall diagnostic yield was 78.3%, with 60.9% of cases identified as malignant. ROSE exhibited a sensitivity of 94.4% and a specificity of 100%, demonstrating significant agreement (kappa=0.881) with final pathological results. The mean procedure duration was 43.9 min, with minimal complications, including mild bleeding in 8.7% of cases.


Conclusion
The findings underscore the effectiveness of VBN combined with ROSE in diagnosing PPLs, offering a reliable and safer alternative to conventional methods in challenging scenarios.