Diagnostic Value of Multiplane Tool in Virtual Lesion Confirmation in Augmented Fluoroscopy-Guided Navigational Bronchoscopy for Peripheral Pulmonary Lesions
Erik Büscher, Kaid Darwiche, Marcel Opitz, Jane Winantea, Hanna Zellerhoff, Johannes Wienker, Sebastian Zensen, Halil I. Tazeoglu, Luca Salhöfer, Johannes Haubold, Jan Büscher, Anika Hüsing, Christian Taube, Lonny Yarmus, Jeffrey Thiboutot, Faustina FunkeBackground:
The demand for minimally invasive diagnostic techniques for peripheral pulmonary lesions (PPL) is rising. Augmented fluoroscopy (AF) provides real-time guidance by overlaying CT-derived virtual targets onto fluoroscopic images, yet its diagnostic value remains poorly defined.
Methods:
We retrospectively analyzed 226 PPLs targeting procedures performed with navigational bronchoscopy supplemented by AF and R-EBUS between December 2019 and March 2024. TIVL was assessed across 5 standard planes (posteroanterior, 30 degrees toward, 30 degrees away, 30 degrees clockwise, and 30 degrees counterclockwise). Diagnostic yield was defined according to the ATS/ACCP strict criteria. Multivariable logistic regression identified predictors of diagnostic success.
Results:
Of the 226 analyzed PPLs, 101 (44.7%) showed no R-EBUS signal. In lesions without an R-EBUS signal, diagnostic yield increased from 0% with ≤1 plane to 42% with ≥4 planes. In multivariable analysis, TIVL in 3 planes was associated with a >5-fold higher likelihood of diagnostic success (OR: 5.57;
Conclusion:
The number of fluoroscopic planes with confirmed TIVL is a significant determinant of diagnostic yield in AF-guided navigational bronchoscopy, particularly in lesions lacking R-EBUS signals. Multiplane TIVL assessment may enhance diagnostic performance in centers without cone-beam CT or digital tomosynthesis availability.