What Is the Use of CT Scans?
The identification of atypical chest CT scans is a prevalent occurrence within the field of pulmonary medicine. Among individuals at a heightened risk for developing lung cancer who underwent screening, it was observed that a subset of patients exhibited an abnormality in their chest computed tomography (CT) scan.
-
The likelihood of malignancy in an abnormal chest CT scan is contingent upon the specific attributes of the abnormality observed, as well as the clinical characteristics of the patient, including age and smoking history. The timely identification and surgical removal have demonstrated enhanced patient survival rates.
-
In cases where the likelihood of malignancy is low, it is recommended to employ a strategy of conducting sequential CT scans to observe any potential growth in the size of the lesion over a period of time.
-
The management strategy for patients with a moderate likelihood of malignancy or those who are at a heightened surgical risk often entails performing a biopsy of the lesion.
-
A diagnostic approach that can be employed is CT-guided biopsy, which has shown sensitivity in accurately diagnosing cancer. Consequently, certain individuals have embarked on a quest to discover an improved diagnostic technology.
What Is the Use of Electromagnetic Navigational Bronchoscopy?
-
During a navigational bronchoscopy, a specialized type of bronchoscope is used to investigate and treat lung lesions located in parts of the lungs that cannot be reached with a standard bronchoscope. An electromagnetic navigation system and immediate time computed tomography (CT) pictures are used in the navigational bronchoscopy procedure, which results in the creation of a three-dimensional representation of the lungs.
-
The utilization of electromagnetic navigational bronchoscopy (ENB) in coincidence with transbronchial biopsy has become a progressively prevalent technological approach for the diagnosis of nodules.
-
The utilization of navigational bronchoscopy has been recognized as a technological advancement that enhances the sensitivity of conventional bronchoscopy. The technology has been previously evaluated and has demonstrated an enhancement in the sensitivity of transbronchial biopsy.
-
Both CT-guided and ENB strategies can lead to inconclusive biopsy results where a patient is eligible for surgery, Video-Assisted Thoracic Surgery (VATS) resection of the Solitary Pulmonary Nodule (SPN) is frequently conducted to achieve a conclusive diagnosis.
What Are the Benefits of the Test?
Electromagnetic navigation bronchoscopy entails a lower risk of pneumothorax and other complications compared to CT-guided biopsy, a competing diagnostic technique for the diagnosis of a single lung nodule. Nevertheless, the ENB biopsy strategy is associated with a higher rate of VATS surgery and a higher cost. This strategy reduces the incidence of pneumothoraces, chest tubes, hemorrhage, and respiratory failure.
The preponderance of the difference in cost per biopsy between ENB and CT-guided biopsy is due to the high sensitivity of CT-guided biopsy and the need to use an additional diagnostic tool to confirm a diagnosis following a non-diagnostic ENB biopsy. Several variables, such as the "bronchus sign," the size of the lesion, and its location within the chest, have been observed to impact the sensitivity of ENB and CT-guided biopsies. These parameters have an impact on the relative sensitivity of ENB and CT-guided biopsies despite not being considered separately.
When a new diagnostic technology is introduced to the market, numerous studies are conducted to characterize its functional properties, particularly its sensitivity and specificity relative to an existing technology or a gold standard. In real-world situations, diagnostic tests are not typically used alone. By integrating diagnostic tests, healthcare providers frequently attempt to optimize specific aspects of their operational features.
What Are the Disadvantages of the Test?
When evaluating the SPN, PET scans are frequently performed, and a PET-avid lesion is associated with an increased likelihood of malignancy following the test. We made this decision because we believed that the PET result impacted our model indirectly through the pretest likelihood of malignancy rather than directly. Figure 2 demonstrates that the likelihood of disease at the time of the test had little impact on the cost of the CT-guided biopsy procedure and the ENB biopsy strategy.
Since biopsies have the same sensitivity for benign and malignant diseases, a non-diagnostic biopsy has no appreciable impact on the post-test probability of cancer. As a result of their decision to undergo a diagnostic procedure, both the patient and the provider have expressed a strong desire to receive a diagnosis.
Other disadvantages include having to rely on figures from the scientific literature that may not apply to all patient populations and the lack of original patient-level data.
The effects of CT-guided biopsy and ENB biopsy can vary greatly depending on how these technologies are employed in the evaluation of the SPN in ways that go beyond cost and sensitivity. Future research should focus on gaining an understanding of the multidisciplinary context in which malignancy is evaluated, including the impact of organizational variables such as a "multidisciplinary nodule clinic" on resource utilization and patient-centered outcomes. To comprehend why and under what circumstances physicians and patients prefer one diagnostic technique over another, provider and patient preferences should also be considered during the decision-making process.
Conclusion:
The utilization of navigational bronchoscopy with biopsy, as opposed to CT-guided biopsy of the solitary pulmonary nodule (SPN), leads to a reduction in the occurrence of pneumothorax, hemorrhage, and respiratory failure. However, this approach is accompanied by an average cost increase per case and is linked to a definite rise in rates of video-assisted thoracoscopic surgery (VATS) procedures. The implementation of a diagnostic approach that involves the sequential utilization of CT-guided biopsy and ENB biopsy has been shown to result in a reduction in the frequency of VATS procedures and a decrease in associated expenses. The implementation of an ENB-first sequential biopsy strategy results in a reduction in the average cost per case compared to CT-guided biopsy. The implementation of a sequential biopsy approach, with CT biopsy as the initial step, results in a reduction in the cost per case when compared to the utilization of CT-guided biopsy as the sole method.
