Abstract
Transbronchial biopsies are often employed to definitively diagnose peripheral pulmonary lesions. Although this technique is associated with fewer complications than percutaneous biopsies, the diagnostic yield is low and the method requires the bronchoscopist to guide the bronchoscope and biopsy instruments to the lesion. Virtual bronchoscopic navigation (VBN), an exclusive system of which is now commercially available, can be used to guide the bronchoscope to peripheral lesions under direct visualization using virtual bronchoscopy images of the bronchial route. VBN is applied in combination with CT-guided ultrathin bronchoscopy, endobronchial ultrasonography with a guide sheath (EBUS-GS) and fluoroscopy- and non-fluoroscopy-assisted bronchoscopy, with a reported rate of diagnosis of peripheral pulmonary lesions and tumors measuring 2 cm or smaller of 74% and 67.5%, respectively. In a randomized controlled study, the combination of VBN and EBUS-GS increased the diagnostic yield, while that combined with ultrathin bronchoscopy improved the rate of diagnosis of lesions located in the right upper lobe or peripheral third of the lung field and those invisible on posterior-anterior radiographs, according to a subanalysis. In order to increase the diagnostic yield of VBN, it is important to clarify the relationship between the lesion and the extracted bronchus used to construct virtual bronchoscopic images on CT and select the appropriate combination bronchoscopy procedure. VBN is a useful method for supporting bronchoscopy whose further spread and advancement is desirable.
