Navigation-assisted bronchoscopy for ground-glass opacity lesions

We thank Dr. Chaves and colleagues for their interest and comments on our article (1). We have attempted to diagnose ground-glass opacity (GGO)-predominant-type lesions by bronchoscopic biopsy using endobronchial ultrasonography with a guide sheath (EBUS-GS) (1,2). The diagnostic rate of GGO-predominant-type lesions is lower than that of solid-type lesions. One of the reasons for this is that the lesions may not be visible under X-ray fluoroscopy. Identifying the bronchial routes to reach GGO lesions within a limited examination time is not easy. We have previously reported a retrospective study that evaluated the efficacy of EBUS-GS combined with a virtual bronchoscopic navigation (VBN) system for diagnosing GGO-predominant-type lesions (1). The VBN system provides virtual images of the bronchial path to a peripheral lesion obtained from computed tomography (CT) digital imaging and communications in medicine (DICOM) data. In that study, we showed that VBN increased the diagnostic yield of GGO-predominant-type lesions from 57% to 69% by transbronchial biopsy (TBB) using EBUS-GS. Furthermore, in pure GGO lesions, the combination of VBN and EBUS-GS increased the diagnostic yield from 45% to 65%. We concluded in that study that addition of VBN to EBUS-GS can be more useful than EBUS-GS alone for diagnosing GGO predominant-type lesions