{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:47:03Z","timestamp":1790174823247,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>Diagnosing intraparenchymal pulmonary lesions lacking a bronchus sign remains challenging. Bronchoscopic transparenchymal nodule access (BTPNA) for reaching such lesions has seen limited clinical adoption due to insufficient evidence and practical challenges. This study evaluates the feasibility and diagnostic yield of a modified BTPNA (mBTPNA) technique\u2014referred to as the \u2018Essen tunnel\u2019\u2014which eliminates the need for a guide sheath.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on patients undergoing virtual bronchoscopic navigation (VBN) incorporating the mBTPNA technique at our centre, from December 2019 to March 2024. The \u2018Essen tunnel\u2019 was created by a needle under virtual navigation guidance, enabling direct insertion of an ultrathin bronchoscope (UTB) or radial endobronchial ultrasound (R\u2010EBUS) probe to biopsy intraparechymal lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 266 lesions targeted via VBN, 37 (14%) intraparenchymal lesions (mean target length: 12.7\u2009\u00b1\u20094.1\u2009mm) were accessed using mBTPNA. The tunnel was successfully created in 97.3% of cases with UTB intubation in 51.4%. R\u2010EBUS was inserted into the tunnel in 83.8% of cases. Semicircular to circular patterns (SCP) were detected in 19.4% before and 61.3% after tunnel creation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). SCP presence on R\u2010EBUS following mBTPNA was associated with a diagnostic accuracy of 66.7%, comparable to that observed in non\u2010tunnel lesions exhibiting a bronchus sign (72.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.58). No severe complications were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The mBTPNA technique is a feasible and safe method that enhances endosonographic lesion detection and achieves promising diagnostic accuracy for challenging intraparenchymal lesions.<\/jats:p><jats:p>\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70053-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.70053","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T07:08:44Z","timestamp":1747811324000},"page":"851-860","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Feasibility of a Modified Bronchoscopic Transparenchymal Nodule Access Technique (\u2018Essen Tunnel\u2019) for Improving\u00a0the Diagnosis of Intraparenchymal Pulmonary Lesions"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2300-239X","authenticated-orcid":false,"given":"Erik","family":"B\u00fcscher","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, Division of Interventional Pneumology University Hospital Essen \u2010 Ruhrlandklinik  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faustina","family":"Funke","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Division of Interventional Pneumology University Hospital Essen \u2010 Ruhrlandklinik  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Winantea","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Division of Interventional Pneumology University Hospital Essen \u2010 Ruhrlandklinik  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Zellerhoff","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Division of Interventional Pneumology University Hospital Essen \u2010 Ruhrlandklinik  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Wienker","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Division of Interventional Pneumology University Hospital Essen \u2010 Ruhrlandklinik  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Opitz","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Taube","sequence":"additional","affiliation":[{"name":"Department of Pulmonary 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