Radial‐EBUS and virtual bronchoscopy planner for peripheral lung cancer diagnosis: How it became the first‐line endoscopic procedure

BACKGROUND: Various advanced bronchoscopy methods have been developed to reach peripheral lung lesions (PLL). In a large cohort, we aimed to assess a standardized procedure of first‐line radial‐endobronchial ultrasound (r‐EBUS) and virtual bronchoscopy planner for the diagnosis of peripheral lung cancer. METHODS: This retrospective, single center study included patients who had r‐EBUS‐guided bronchoscopy for the diagnosis of a PLL between 2008 and 2019. Cases without a final diagnosis of cancer or follow‐up were excluded. RESULTS: Between 2008 and 2019, 2735 patients had a r‐EBUS procedure, among whom 1627 had a final diagnosis of cancer and were included in the present study. Over the 12‐year study period, r‐EBUS became the first‐line endoscopic procedure to assess PLL (25% as first‐line bronchoscopy in 2008 vs. 92% in 2019). The frequency of the bronchus sign decreased from 2009 to 2019 (100% to 80%; p = 0.001), whereas US visualization of the lesion remained stable (88%). The median number of biopsies increased from two (2008 to 2014) to four (2015 to 2019) (p < 0.0001), with the same diagnostic efficiency (74% total and 80% when a bronchus sign was present). Of the 651 adenocarcinomas, molecular analysis was possible in 86%. PD‐L1 expression analysis was possible in 81% of cases. During the study period, the lifetime of the radial probe increased from 57 procedures to 77 procedures/probe. CONCLUSION: Because r‐EBUS and VB planner is easy to perform under local anesthesia, inexpensive and efficient it can be used as a first‐line procedure to assess peripheral lung cancer.