Ultrathin Bronchoscope and Radial Endobronchial Ultrasound (R-EBUS) With Fluoroscopy Versus Standard Fiberoptic Bronchoscopy (FB) (P00029233 )

Not Applicable

Completed

Interventions: Device: Standard FB with fluoroscopy
Device: R-EBUS with ultrathin bronchoscope

Brief Summary: The purpose of this study is to compare the yield of two methods for obtaining a lung tissue sample: Procedure #1: standard fiberoptic bronchoscopy (FB) with fluoroscopy, and Procedure #2: ultrathin bronchoscope procedure with fluoroscopy and radial endobronchial ultrasound (R-EBUS). These two procedures are similar in that they both: (1) enable your doctor to look inside your lungs with a device called a bronchoscope, and (2) Use fluoroscopy, which is a technique that uses X-rays to see your lungs.

This will give the doctor an opportunity to use either of the bronchoscopy methods described above and compare the tests to see if R-EBUS provides better results than standard bronchoscopy.

Recruitment & Eligibility

Inclusion Criteria

Patients with a solid lung lesion 2-5cm identified on chest CT with the intention to undergo bronchoscopic evaluation. If the lesion is partially solid (ie there is a ground glass component) then the solid portion must make up >75% of the lesion and measure at 2-5cm.The decision to pursue biopsy will be made by the treating physician and agreed upon by the patient. This will include patients determined to have an intermediate risk of malignancy (5-65%) and those non-surgical candidate with higher risk lesions in need of diagnosis for alternative treatment. OR
Patients with a solid lung lesion 2-5cm identified on chest CT that are surgical candidates with a high probability of cancer (>65%) will be referred for surgical evaluation. If the lesion is partially solid (ie there is a ground glass component) then the solid portion must make up >75% of the lesion and measure at 2-5cm. If the patient refuses surgery or if the surgeon requests a definitive diagnosis prior to surgery the patient will have the option to be included in this study. All sites will use the same online calculator to document probability of malignancy.
Are at least 22 years old,
Lack Bleeding disorders, and
Are able to provide informed consent

Exclusion Criteria

Patients with a pure ground-glass opacity identified on chest CT
Patients with endobronchial involvement seen on chest CT.
Patients who refuse to participate,
Are less than 22 years of age,
Lack fitness to undergo flexible bronchoscopy as determined by the bronchoscopist prior to procedure, and
Are unable to provide informed consent
Pregnant

Arm && Interventions

Group	Intervention	Description
Standard FB with fluoroscopy	Standard FB with fluoroscopy	Administration of moderate or deep sedation, introduction of standard adult bronchoscope into the airway. Following application of topical anesthesia on vocal cord, trachea, bronchoscope is advanced distally under direct visualization. Localization of the lesion using fluoroscopy followed by the acquisition of pathologic and cytologic specimens using standard bronchial brush and standard transbronchial biopsy forceps. Evaluation of acquired samples for pathology. Performance of a portable chest X-ray to look for pneumothorax (PTX).
R-EBUS with ultrathin bronchoscope	R-EBUS with ultrathin bronchoscope	Administration of moderate or deep sedation, introduction of ultrathin bronchoscope into the airway. Following application of topical anesthesia on vocal cord, trachea, bronchoscope is advanced distally under direct visualization. Attempt to definitively locate the lesion with mechanical R-EBUS probe. Acquisition of pathologic and cytologic specimens using standard bronchial brush and standard transbronchial biopsy forceps. Performance of a portable chest X-ray to look for PTX.

Primary Outcome Measures

Name	Time	Method
Diagnostic Yield of Procedures; Number of Positive Diagnosis of Pulmonary Lesions	From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months	Diagnostic yield of standard FB with fluoroscopy using standard adult bronchoscope versus bronchoscopy using ultrathin bronchoscope in combination with R-EBUS with or without Guidesheath for lung lesions 2-5 cm.

Secondary Outcome Measures

Name	Time	Method

Locations (5): University of Florida
🇺🇸
Gainesville, Florida, United States
Medstar Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Johns Hopkins University
🇺🇸
Baltimore, Maryland, United States
Washington University Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States