WCLC 2025 - Posters & ePosters-PT1.05.04 Use of an Ultrathin Bronchoscope With a Larger Working Channel Enhances Diagnostic Yield in Cone-Beam CT-Guided Transbronchial Biopsy

PT1.05.04 Use of an Ultrathin Bronchoscope With a Larger Working Channel Enhances Diagnostic Yield in Cone-Beam CT-Guided Transbronchial Biopsy

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This retrospective study compared the diagnostic yield and procedural outcomes of two types of ultrathin bronchoscopes (UTBs) used in cone-beam computed tomography (CBCT)-guided transbronchial biopsy (TBB) for peripheral pulmonary lesions ≤30 mm. Patients treated between 2016 and 2024 underwent CBCT-guided TBB with virtual bronchoscopic navigation (VBN). Two groups were analyzed: the small channel UTB (SC-UTB, 1.2 mm working channel) group and the large channel UTB (LC-UTB, 1.7 mm working channel) with radial endobronchial ultrasound (R-EBUS) assistance.<br /><br />The study included 165 patients (SC-UTB, n=89; LC-UTB, n=76) with similar baseline characteristics. Using inverse probability of treatment weighting to adjust for confounders, results showed a significantly higher overall diagnostic yield in the LC-UTB group (75.7%) compared to SC-UTB (64.9%, p=0.04). Histological (63.4% vs 50.0%, p=0.018) and cytological diagnostic yields (63.8% vs 46.1%, p=0.002) were also significantly better with LC-UTB. The LC-UTB group required fewer CBCT scans (median 1 vs 1-2 scans, p=0.001) and had a lower rate of re-navigation after CBCT (26.1% vs 47.4%, p=0.001). Procedure time and complication rates (pneumothorax, respiratory failure) were comparable between groups.<br /><br />The improved yield with the LC-UTB is likely due to the larger working channel allowing use of bigger biopsy forceps and the addition of R-EBUS facilitating early lesion localization. The findings support using LC-UTB with R-EBUS assistance as the preferred technique for CBCT-guided UTB-TBB of small peripheral lung lesions, optimizing diagnostic performance while maintaining safety.<br /><br />In conclusion, incorporating a larger working channel ultrathin bronchoscope with R-EBUS and CBCT guidance significantly enhances biopsy diagnostic success for peripheral pulmonary lesions ≤30 mm.

Asset Subtitle

Naoya Kawakita

Meta Tag

Speaker Naoya Kawakita

Topic Pulmonology and Staging

Keywords

ultrathin bronchoscope

large channel UTB

small channel UTB

cone-beam computed tomography

transbronchial biopsy

peripheral pulmonary lesions

virtual bronchoscopic navigation

radial endobronchial ultrasound

diagnostic yield

biopsy forceps