The Impact of Alternative Approaches to Diagnostic Yield Calculation in Studies of Bronchoscopy

摘要

In recent years, there have been notable advancements in the guidance technologies for peripheral bronchoscopy, including newer electromagnetic navigation platforms, cone beam CT, augmented fluoroscopy, digital tomosynthesis, and robot-assisted bronchoscopy.1Chen A.C. Pastis Jr., N.J. Mahajan A.K. et al.Robotic bronchoscopy for peripheral pulmonary lesions: a multicenter pilot and feasibility study (BENEFIT).Chest. 2021; 159: 845-852Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar, 2Fielding D.I.K. Bashirzadeh F. Son J.H. et al.First human use of a new robotic-assisted fiber optic sensing navigation system for small peripheral pulmonary nodules.Respiration. 2019; 98: 142-150Crossref PubMed Scopus (55) Google Scholar, 3Folch E.E. Pritchett M.A. Nead M.A. et al.Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: one-year results of the prospective, multicenter NAVIGATE study.J Thorac Oncol. 2019; 14: 445-458Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar, 4Pritchett M.A. Schampaert S. de Groot J.A.H. Schirmer C.C. van der Bom I. Cone-beam CT with augmented fluoroscopy combined with electromagnetic navigation bronchoscopy for biopsy of pulmonary nodules.J Bronchology Interv Pulmonol. 2018; 25: 274-282Crossref PubMed Scopus (75) Google Scholar, 5Aboudara M. Roller L. Rickman O. et al.Improved diagnostic yield for lung nodules with digital tomosynthesis-corrected navigational bronchoscopy: initial experience with a novel adjunct.Respirology. 2020; 25: 206-213Crossref PubMed Scopus (27) Google Scholar, 6Cicenia J. Bhadra K. Sethi S. Nader D.A. Whitten P. Hogarth D.K. Augmented fluoroscopy: a new and novel navigation platform for peripheral bronchoscopy.J Bronchology Interv Pulmonol. 2021; 28: 116-123Crossref PubMed Scopus (9) Google Scholar, 7Benn B.S. Romero A.O. Lum M. Krishna G. Robotic-assisted navigation bronchoscopy as a paradigm shift in peripheral lung access.Lung. 2021; 199: 177-186Crossref PubMed Scopus (13) Google Scholar As a result, multiple recent trials evaluating the performance of these technologies have been reported. The most frequently employed assessment metric is diagnostic accuracy, frequently termed diagnostic yield (DY) in the bronchoscopy literature, yet there remains no standardized approach to measurement of this outcome in studies of bronchoscopy. The use of variable definitions of DY may influence the interpretation of study results and limit the ability to compare findings across studies. The aim of this analysis is to illustrate and quantify the impact of different methodological approaches on DY estimates. We generated a hypothetical cohort of 1,000 patients undergoing bronchoscopy by extrapolating data from a prospective study of robot-assisted bronchoscopy.1Chen A.C. Pastis Jr., N.J. Mahajan A.K. et al.Robotic bronchoscopy for peripheral pulmonary lesions: a multicenter pilot and feasibility study (BENEFIT).Chest. 2021; 159: 845-852Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar We calculated DY, defined as the rate of true positives (TPs) (for malignancy) plus true negatives (TNs), using three alternative definitions commonly employed in the literature.1Chen A.C. Pastis Jr., N.J. Mahajan A.K. et al.Robotic bronchoscopy for peripheral pulmonary lesions: a multicenter pilot and feasibility study (BENEFIT).Chest. 2021; 159: 845-852Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar,3Folch E.E. Pritchett M.A. Nead M.A. et al.Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: one-year results of the prospective, multicenter NAVIGATE study.J Thorac Oncol. 2019; 14: 445-458Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar,8Ost D.E. Ernst A. Lei X. et al.Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. results of the AQuIRE registry.Am J Respir Crit Care Med. 2016; 193: 68-77Crossref PubMed Scopus (248) Google Scholar In all methods, bronchos