HIGH DIAGNOSTIC YIELD IN SAMPLING SUB-CENTIMETER PERIPHERAL PULMONARY NODULES WITH ROBOTIC-ASSISTED BRONSCHOSCOPY

The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB has been introduced as a method to overcome these shortcomings. We describe our initial experience in evaluating lung nodules with robotic assisted bronchoscopy. We retrospectively reviewed data on the first 25 patients that underwent robotic-assisted bronchoscopy and biopsy. We analyzed success with localization, diagnostic yield, and post procedural morbidity. Diagnostic yield was 96% (24/25) with no periprocedural morbidity. The majority of nodules were malignant or atypical (76%) and were located in the right upper lobe. Diameter ranged between 0.8–6.9 cm (median size 1–2 cm). Seventy-five percent of patients underwent subsequent treatment for cancer based on these results, with 25% having continued surveillance. Robotic assisted bronchoscopy is safe and accurate. Studies with larger numbers will allow better understanding of the diagnostic yield and clinical utility of this approach in comparison to other diagnostic tools for lung nodules.

Download Full-text

Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: initial multicenter experience using the Ion™ Endoluminal System

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01693-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael J. Simoff ◽

Michael A. Pritchett ◽

Janani S. Reisenauer ◽

David E. Ost ◽

Adnan Majid ◽

...

Keyword(s):

Target Location ◽

Diagnostic Yield ◽

Research Question ◽

Pulmonary Nodules ◽

Outer Edge ◽

Categorical Variables ◽

Continuous Variables ◽

Clinical Trial Registration ◽

Robotic Assisted ◽

Shape Sensing

Abstract Background Traditional bronchoscopy provides limited approach to peripheral nodules. Shape-sensing robotic-assisted bronchoscopy (SSRAB, Ion™ Endoluminal System) is a new tool for minimally invasive peripheral nodule biopsy. We sought to answer the research question: Does SSRAB facilitate sampling of pulmonary nodules during bronchoscopists’ initial experience? Methods The lead-in stage of a multicenter, single-arm, prospective evaluation of the Ion Endoluminal System (PRECIsE) is described. Enrolled subjects ≥ 18 years old had recent computed tomography evidence of one or more solid or semi-solid pulmonary nodules ≥ 1.0 to ≤ 3.5 cm in greatest dimension and in any part of the lung. Subjects were followed at 10- and 30-days post-procedure. This stage provided investigators and staff their first human experience with the SSRAB system; safety and procedure outcomes were analyzed descriptively. Neither diagnostic yield nor sensitivity for malignancy were assessed in this stage. Categorical variables are summarized by percentage; continuous variables are summarized by median/interquartile range (IQR). Results Sixty subjects were enrolled across 6 hospitals; 67 nodules were targeted for biopsy. Median axial, coronal and sagittal diameters were < 18 mm with a largest cardinal diameter of 20.0 mm. Most nodules were extraluminal and distance from the outer edge of the nodule to the pleura or nearest fissure was 4.0 mm (IQR: 0.0, 15.0). Median bronchial generation count to the target location was 7.0 (IQR: 6.0, 8.0). Procedure duration (catheter-in to catheter-out) was 66.5 min (IQR: 50.0, 85.5). Distance from the catheter tip to the closest edge of the virtual nodule was 7.0 mm (IQR: 2.0, 12.0). Biopsy completion was 97.0%. No pneumothorax or airway bleeding of any grade was reported. Conclusions Bronchoscopists leveraged the Ion SSRAB’s functionality to drive the catheter safely in close proximity of the virtual target and to obtain biopsies. This initial, multicenter experience is encouraging, suggesting that SSRAB may play a role in the management of pulmonary nodules. Clinical Trial Registration identifier and date NCT03893539; 28/03/2019.

Download Full-text

High diagnostic yield from transbronchial biopsy of solitary pulmonary nodules using low-dose CT-guidance

Respirology ◽

10.1111/j.1440-1843.2010.01741.x ◽

2010 ◽

Vol 15 (4) ◽

pp. 677-682 ◽

Cited By ~ 11

Author(s):

Hubert HAUTMANN ◽

Markus O. HENKE ◽

Harro BITTERLING

Keyword(s):

Low Dose ◽

Diagnostic Yield ◽

Pulmonary Nodules ◽

Transbronchial Biopsy ◽

Ct Guidance ◽

Solitary Pulmonary Nodules ◽

Low Dose Ct ◽

High Diagnostic Yield

Download Full-text

Endobronchial ultrasound-guided biopsy in the evaluation of intrathoracic lymphadenopathy in suspected tuberculosis: A minimally invasive technique with a high diagnostic yield

Journal of Infection ◽

10.1016/j.jinf.2009.02.003 ◽

2009 ◽

Vol 58 (4) ◽

pp. 309-311 ◽

Cited By ~ 12

Author(s):

Daniel P. Steinfort ◽

Douglas F. Johnson ◽

Tom G. Connell ◽

Louis B. Irving

Keyword(s):

Minimally Invasive ◽

Diagnostic Yield ◽

Minimally Invasive Technique ◽

Endobronchial Ultrasound ◽

Invasive Technique ◽

Ultrasound Guided ◽

High Diagnostic Yield ◽

Guided Biopsy ◽

Suspected Tuberculosis ◽

Ultrasound Guided Biopsy

Download Full-text

High diagnostic yield of splenic core biopsy in patients with pyrexia of unknown origin

British Journal of Haematology ◽

10.1111/bjh.17325 ◽

2021 ◽

Author(s):

Yee Ting Nicole Yim ◽

Gabriel Wallis ◽

Jawad Saeed ◽

Stefan Voo ◽

Irfan Kayani ◽

...

Keyword(s):

Core Biopsy ◽

Diagnostic Yield ◽

Unknown Origin ◽

Pyrexia Of Unknown Origin ◽

High Diagnostic Yield

Download Full-text

Conventional Transbronchial Needle Aspiration (cTBNA) and EBUS-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Retrospective Study on the Comparison of the Two Methods for Diagnostic Adequacy in Molecular Analysis

Journal of Molecular Pathology ◽

10.3390/jmp2040025 ◽

2021 ◽

Vol 2 (4) ◽

pp. 296-305

Author(s):

Francesca Signorini ◽

Martina Panozzi ◽

Agnese Proietti ◽

Greta Alì ◽

Olivia Fanucchi ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Nodes ◽

Molecular Analysis ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Diagnostic Methods ◽

Neoplastic Cells ◽

Transbronchial Needle Aspiration ◽

Average Percentage ◽

High Diagnostic Yield

Introduction: In recent years, there has been a growing development of molecularly targeted therapies for various types of solid tumors—in particular, in non-small-cell lung cancer (NSCLC). This has required the need for greater quantities of tissue that is able to support ancillary studies, alongside cyto-histological diagnoses for the assessment of molecular targets. Conventional TBNA (cTBNA) and EBUS-guided TBNA (EBUS-TBNA) have shown a high diagnostic yield for malignant mediastinal and/or hilar lymph node enlargement and peribronchial masses; however, few studies have compared these two procedures. We retrospectively compared TBNA patients (EBUS-TBNA and cTBNA) in order to determine the diagnostic yield and material adequacy for subsequent ancillary analyses. Materials and Methods: We retrospectively evaluated 318 patients with clinical suspicion of lung cancer or with disease recurrence. All of the patients underwent TBNA (either EBUS-TBNA or cTBNA) on enlarged mediastinal and/or hilar lymph nodes and peribronchial masses between January 2017 and June 2021 at the University Hospital of Pisa, Italy. After a definitive diagnosis, molecular analyses and an evaluation of PD-L1 expression were performed in the cases of adenocarcinoma, squamous cell carcinoma, and NSCLC, not otherwise specified (NOS). Results: EBUS-TBNA was performed in 199 patients and cTBNA was performed in 119 patients with 374 and 142 lymph nodes, respectively. The overall diagnostic yield for positive diagnoses was 59% (diagnostic rate of 61% in EBUS-TBNA, and 55% in cTBNA). Adenocarcinoma (ADC) was the most frequent diagnosis in both methods. EBUS-TBNA diagnostic adequacy was 72% for molecular analysis, while it was 55.5% for cTBNA, showing a statistical trend (p = 0.08) towards the significance of EBUS. The average percentage of neoplastic cells was also statistically different between the two methods (p = 0.05), reaching 51.19 ± 22.14 in EBUS-TBNA and 45.25 ± 22.84 in cTBNA. With regard to the PD-L1 protein expression, the percentage of positivity was similar in both procedures (86% in EBUS-TBNA, 85% in cTBNA). Conclusions: Conventional TBNA (cTBNA) and EBUS-guided TBNA (EBUS-TBNA) are minimally invasive diagnostic methods that are associated with a high diagnostic yield. However, EBUS-TBNA has an improved diagnostic adequacy for molecular analysis compared to cTBNA, and is associated with a higher average percentage of neoplastic cells.

Download Full-text