{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:40:01Z","timestamp":1786653601001,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Conventional bronchoscopic approaches have a lower diagnostic yield (DY) compared to transthoracic biopsy for sampling peripheral pulmonary lesions (PPLs). Cone-beam computed tomography (CBCT)-guided bronchoscopy overcomes the limitations of conventional bronchoscopy techniques. This study evaluates DY, predictors of success, and safety of CBCT-guided bronchoscopy for PPL biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This single-center retrospective study included all consecutive patients who underwent CBCT-guided biopsy for PPLs between November 2023 and November 2024. Clinico-radiologic and procedural details, tool-in-lesion (TIL) relationships, DY, factors predicting DY, and complications were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 183 patients who underwent bronchoscopic sampling of PPL during study period, 50 patients underwent CBCT-guided biopsy. The overall DY of CBCT biopsy was 88% (44\/50). A type 1 TIL (tool within lesion) was obtained in 57% (28\/49), type 2 TIL (tool touch lesion) in 35% (17\/49), and a type 3 TIL (tool away from lesion) in four cases. The factors predicting DY were size of lesion and the tool\u2013lesion relationship. DY increased with increasing size of PPL and decreased the farther the tool was from the center of the target. The DY was 100%, 82%, and 25% for lesions with type 1, type 2, and type 3 TIL, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.024). CBCT biopsy was safe with no procedural mortality, no pneumothorax, and moderate to severe bleed in seven cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>CBCT-guided biopsy for peripheral pulmonary lesions is safe and has a DY of 88%. DY is higher for lesions \u22652 cm and when the tool is within the lesion (type 1 TIL) on CBCT spin.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/lungindia.lungindia_92_25","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T16:00:13Z","timestamp":1752508813000},"page":"502-509","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Cone beam computed tomography-guided bronchoscopic sampling of peripheral pulmonary lesions: The first Indian experience"],"prefix":"10.4103","volume":"42","author":[{"given":"Venkata Nagarjuna","family":"Maturu","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Hitec City, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vipul Kumar","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Hitec City, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virender Pratibh","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Hitec City, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinoosha","family":"Rachel","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Hitec City, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishan Srikanth","family":"Juvva","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Hitec City, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai Sindhu","family":"Kotla","sequence":"additional","affiliation":[{"name":"Department of Pathology, Yashoda Super Speciality Hospitals, Hitec City, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"R1-20260422","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/jama.2021.24287","article-title":"Evaluating the patient with a pulmonary nodule: A review","volume":"327","author":"Mazzone","year":"2022","journal-title":"JAMA"},{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"7330","DOI":"10.3390\/jcm13237330","article-title":"CT-guided transthoracic core-needle biopsy of pulmonary nodules: Current practices, efficacy, and safety considerations","volume":"13","author":"Constantinescu","year":"2024","journal-title":"J Clin Med"},{"key":"R3-20260422","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1378\/chest.11-1764","article-title":"Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule","volume":"142","author":"Wang Memoli","year":"2012","journal-title":"Chest"},{"key":"R4-20260422","doi-asserted-by":"crossref","first-page":"361","DOI":"10.21037\/atm-22-2845","article-title":"Cone-beam CT in lung biopsy: A clinical practice review on lessons learned and future perspectives","volume":"11","author":"Verhoeven","year":"2023","journal-title":"Ann Transl Med"},{"key":"R5-20260422","doi-asserted-by":"crossref","first-page":"240046","DOI":"10.1183\/16000617.0046-2024","article-title":"Diagnostic yield and safety of diagnostic techniques for pulmonary lesions: Systematic review, meta-analysis and network meta-analysis","volume":"33","author":"Balasubramanian","year":"2024","journal-title":"Eur Respir Rev"},{"key":"R6-20260422","doi-asserted-by":"crossref","first-page":"231","DOI":"10.7150\/jca.8834","article-title":"Cone beam computertomography (CBCT) in interventional chest medicine-High feasibility for endobronchial realtime navigation","volume":"5","author":"Hohenforst-Schmidt","year":"2014","journal-title":"J Cancer"},{"key":"R7-20260422","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/LBR.0000000000000756","article-title":"Lung navigation ventilation protocol to optimize biopsy of peripheral lung lesions","volume":"29","author":"Bhadra","year":"2022","journal-title":"J Bronchology Interv Pulmonol"},{"key":"R8-20260422","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1164\/rccm.202401-0192ST","article-title":"Assessment of advanced diagnostic bronchoscopy outcomes for peripheral lung lesions: A delphi consensus definition of diagnostic yield and recommendations for patient-centered study designs. An official American thoracic society\/American college of chest physicians research statement","volume":"209","author":"Gonzalez","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"R9-20260422","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3390\/diagnostics14020197","article-title":"Severity of atelectasis during bronchoscopy: Descriptions of a new grading system (A telectasisSe verity S coring S ystem-\u201cASSESS\u201d) and at-risk-lung zones","volume":"14","author":"Khan","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"R10-20260422","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.pulmoe.2020.12.006","article-title":"Efficacy of radial endobronchial ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL.s): A systematic review and meta-analysis","volume":"29","author":"Sryma","year":"2023","journal-title":"Pulmonology"},{"key":"R11-20260422","doi-asserted-by":"crossref","first-page":"17534666211017048","DOI":"10.1177\/17534666211017048","article-title":"Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis","volume":"15","author":"Giri","year":"2021","journal-title":"Ther Adv Respir Dis"},{"key":"R12-20260422","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/LBR.0000000000000883","article-title":"Diagnostic yield of cone-beam-derived augmented fluoroscopy and ultrathin bronchoscopy versus conventional navigational bronchoscopy techniques","volume":"30","author":"DiBardino","year":"2023","journal-title":"J Bronchology Interv Pulmonol"},{"key":"R13-20260422","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3390\/diagnostics12010041","article-title":"Cone-beam computed tomography-derived augmented fluoroscopy improves the diagnostic yield of endobronchial ultrasound-guided transbronchial biopsy for peripheral pulmonary lesions","volume":"12","author":"Lin","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"R14-20260422","doi-asserted-by":"crossref","first-page":"5953","DOI":"10.21037\/jtd.2018.09.16","article-title":"Biopsy of peripheral lung nodules utilizing cone beam computer tomography with and without trans bronchial access tool: A retrospective analysis","volume":"10","author":"Sobieszczyk","year":"2018","journal-title":"J Thorac Dis"},{"key":"R15-20260422","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1159\/000510763","article-title":"Cone-beam computed tomography-guided electromagnetic navigation for peripheral lung nodules","volume":"100","author":"Kheir","year":"2021","journal-title":"Respiration"},{"key":"R16-20260422","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/LBR.0000000000000936","article-title":"A cone beam CT bronchoscopy study of the ultrathin cryoprobe for biopsy of peripheral lung lesions","volume":"31","author":"Bhadra","year":"2024","journal-title":"J Bronchology Interv Pulmonol"},{"key":"R17-20260422","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/LBR.0000000000000783","article-title":"Cone-beam CT and augmented fluoroscopy-guided navigation bronchoscopy: Radiation exposure and diagnostic accuracy learning curves","volume":"28","author":"Verhoeven","year":"2021","journal-title":"J Bronchology Interv Pulmonol"},{"key":"R18-20260422","doi-asserted-by":"crossref","first-page":"6950","DOI":"10.21037\/jtd.2018.11.21","article-title":"Cone beam computed tomography-guided thin\/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: A prospective pilot study","volume":"10","author":"Casal","year":"2018","journal-title":"J Thorac Dis"},{"key":"R19-20260422","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1183\/09031936.00011313","article-title":"Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: A feasibility study","volume":"43","author":"Schuhmann","year":"2014","journal-title":"Eur Respir J"},{"key":"R20-20260422","doi-asserted-by":"crossref","first-page":"00135","DOI":"10.1183\/23120541.00135-2019","article-title":"Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions","volume":"5","author":"Kho","year":"2019","journal-title":"ERJ Open Res"},{"key":"R21-20260422","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1159\/000535236","article-title":"Cone-beam computed tomography-guided cryobiopsy combined with conventional biopsy for ground glass opacity-predominant pulmonary nodules","volume":"103","author":"Huang","year":"2024","journal-title":"Respiration"},{"key":"R22-20260422","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.21037\/jtd.2020.03.85","article-title":"Cone beam navigation bronchoscopy: The next frontier","volume":"12","author":"Cheng","year":"2020","journal-title":"J Thorac Dis"},{"key":"R23-20260422","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00408-023-00663-1","article-title":"Transbronchial lung cryobiopsy performed with cone beam computed tomography guidance versus fluoroscopy: A retrospective cohort review","volume":"202","author":"Ali","year":"2024","journal-title":"Lung"}],"container-title":["Lung India"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/lungindia.lungindia_92_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:39:53Z","timestamp":1786649993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/lungindia.lungindia_92_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":23,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/lungindia.lungindia_92_25","relation":{},"ISSN":["0970-2113","0974-598X"],"issn-type":[{"value":"0970-2113","type":"print"},{"value":"0974-598X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"2025-02-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}