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

Marta Viscuso; Roel L J Verhoeven; Stephan E P Kops; Gerjon Hannink; Rocco Trisolini; Erik H F M van der Heijden

doi:10.1016/j.ejso.2024.108341

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

Eur J Surg Oncol. 2024 Apr 15;50(6):108341. doi: 10.1016/j.ejso.2024.108341. Online ahead of print.

Authors

Marta Viscuso¹, Roel L J Verhoeven², Stephan E P Kops³, Gerjon Hannink⁴, Rocco Trisolini⁵, Erik H F M van der Heijden⁶

Affiliations

¹ Department of Pulmonary Diseases, Radboudumc, Nijmegen, the Netherlands; Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Electronic address: marta.viscuso@guest.policlinicogemelli.it.
² Department of Pulmonary Diseases, Radboudumc, Nijmegen, the Netherlands. Electronic address: Roel.LJ.Verhoeven@radboudumc.nl.
³ Department of Pulmonary Diseases, Radboudumc, Nijmegen, the Netherlands. Electronic address: Stephan.Kops@radboudumc.nl.
⁴ Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands. Electronic address: gerjon.hannink@radboudumc.nl.
⁵ Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Electronic address: rocco.trisolini@policlinicogemelli.it.
⁶ Department of Pulmonary Diseases, Radboudumc, Nijmegen, the Netherlands. Electronic address: Erik.vanderHeijden@radboudumc.nl.

PMID: 38636250
DOI: 10.1016/j.ejso.2024.108341

Abstract

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.

Keywords: Cone beam CT; Metastatic lesions; Navigation bronchoscopy; Propensity score matching; Sensitivity.