Diagnostic Yield of Digital Tomosynthesis-assisted Navigational Bronchoscopy for Indeterminate Lung Nodules

Background: Several advanced bronchoscopy platforms are currently available, but the clinical data supporting their use vary. Electromagnetic navigation bronchoscopy (ENB) remains the dominant technology; it is limited by its reliance on preoperative computed tomography, which only approximates patient anatomy during the procedure. Recently, ENB was enhanced with the (1) addition of digital tomosynthesis-based navigation correction, (2) improvements in planning algorithms, and (3) continuous real-time guidance (Illumisite™; Medtronic, Minneapolis, MN, USA). There are currently no clinical data on the diagnostic yield and safety profile of this system. Objectives: The primary objective of this study is to describe the diagnostic yield of the first 100 pulmonary parenchymal lesions sampled using the multimodality navigation bronchoscopy (MNB) platform. The secondary objective is to describe safety. Methods: In this single-center prospective observational study, a database was maintained to track patient, procedural, and outcome data for the first 100 consecutive lesions sampled using the MNB platform at an academic quaternary referral center. Descriptive statistics and univariate and multivariate analyses are reported. Results: The overall diagnostic yield of samples acquired was 79% (79/100). In the cohort where digital tomosynthesis was used, the diagnostic yield was 83% (69/83). Sensitivity for malignancy was 71% (52/73). Overall complication rates were low: pneumothorax (n = 3, 3%) and bleeding requiring intervention (n = 2, 2%). There were no procedural-related hospital admissions. Conclusions: The MNB system performed favorably. Platform superiority cannot be established without future prospective and comparative studies.

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Detection of lung nodules in chest digital tomosynthesis (CDT): effects of the different angular dose distribution

10.1117/12.2081767 ◽

2015 ◽

Author(s):

Byungdu Jo ◽

Youngjin Lee ◽

Dohyeon Kim ◽

Dong-Hoon Lee ◽

Seong-Soo Jin ◽

...

Keyword(s):

Dose Distribution ◽

Lung Nodules ◽

Digital Tomosynthesis

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Lung Nodule Management: An Interventional Pulmonology Perspective

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0038-1676775 ◽

2018 ◽

Vol 39 (06) ◽

pp. 661-666

Author(s):

Jonathan Kurman ◽

Amit Mahajan ◽

D. Hogarth ◽

Udit Chaddha

Keyword(s):

Diagnostic Yield ◽

Lung Nodule ◽

Lung Nodules ◽

Interventional Pulmonology ◽

Technical Aspects ◽

Factors Affecting ◽

Comprehensive Knowledge

AbstractWith the rising number of screening and incidentally detected lung nodules, there is an increasing need for evaluation in the safest and least invasive manner. The last two decades have seen substantial evolution in bronchoscopic approaches to diagnose these nodules. Innovative bronchoscopic techniques, often used in conjunction with each other, have significantly improved our ability to navigate to almost any part of the lung. A comprehensive knowledge of available technologies and the factors affecting diagnostic yield is essential to decide on the best way to approach a particular scenario. This article provides an overview of the technical aspects, yield, and limitations of these modalities.

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Cone-Beam Computed Tomography-Guided Electromagnetic Navigation for Peripheral Lung Nodules

Respiration ◽

10.1159/000510763 ◽

2021 ◽

pp. 1-8

Author(s):

Fayez Kheir ◽

Sanket R. Thakore ◽

Juan Pablo Uribe Becerra ◽

Mohammad Tahboub ◽

Rahul Kamat ◽

...

Keyword(s):

Computed Tomography ◽

Real Time ◽

Cone Beam Computed Tomography ◽

Diagnostic Yield ◽

Univariate Analysis ◽

Endobronchial Ultrasound ◽

Cone Beam ◽

Lung Nodules ◽

Electromagnetic Navigation ◽

Peripheral Lung

Background: Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive technology for the diagnosis of peripheral pulmonary nodules. However, ENB is limited by the lack of real-time confirmation of various biopsy devices. Cone-beam computed tomography (CBCT) could increase diagnostic yield by allowing real-time confirmation to overcome the inherent divergence of nodule location. Objectives: The aim of this study was to assess the diagnostic yield of ENB plus CBCT as compared with ENB alone for biopsy of peripheral lung nodules. Method: We conducted a retrospective study of patients undergoing ENB before and after the implementation of CBCT. Data from 62 consecutive patients with lung nodules located in the outer two-thirds of the lung who underwent ENB and combined ENB-CBCT were collected. Radial endobronchial ultrasound was used during all procedures as well. Diagnostic yield was defined as the presence of malignancy or benign histological findings that lead to a specific diagnosis. Results: Thirty-one patients had ENB-CBCT, and 31 patients had only ENB for peripheral lung lesions. The median size of the lesion for the ENB-CBCT group was 16 (interquartile range (IQR) 12.6–25.5) mm as compared to 21.5 (IQR 16–27) mm in the ENB group (p = 0.2). In the univariate analysis, the diagnostic yield of ENB-CBCT was 74.2% and ENB 51.6% (p = 0.05). Following multivariate regression analysis adjusting for the size of the lesion, distance from the pleura, and presence of bronchus sign, the odds ratio for the diagnostic yield was 3.4 (95% CI 1.03–11.26, p = 0.04) in the ENB-CBCT group as compared with ENB alone. The median time for the procedure was shorter in patients in the ENB-CBCT group (74 min) than in those in the ENB group (90 min) (p = 0.02). The rate of adverse events was similar in both groups (6.5%, p = 0.7). Conclusions: The use of CBCT might increase the diagnostic yield in ENB-guided peripheral lung nodule biopsies. Future randomized clinical trials are needed to confirm such findings.

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High Accuracy of Digital Tomosynthesis-Guided Bronchoscopic Biopsy Confirmed by Intraprocedural Computed Tomography

Respiration ◽

10.1159/000512802 ◽

2021 ◽

pp. 1-8

Author(s):

James Katsis ◽

Lance Roller ◽

Michael Lester ◽

Joyce Johnson ◽

Robert Lentz ◽

...

Keyword(s):

Computed Tomography ◽

Primary Outcome ◽

Diagnostic Yield ◽

Lung Nodule ◽

Digital Tomosynthesis ◽

Biopsy Needle ◽

Bronchoscopic Biopsy ◽

Axial Dimension ◽

Electromagnetic Navigational Bronchoscopy ◽

Room Time

Background: Digital fluoroscopic tomosynthesis-guided electromagnetic navigational bronchoscopy (F-ENB) is a novel adjunct to ENB associated with higher diagnostic yield. The likelihood of F-ENB allowing accurate placement of a biopsy needle within a target remains unclear. Objective: This study intends to determine the accuracy of F-ENB as confirmed by cone-beam computed tomography (CBCT) scan. Methods: Patients undergoing CBCT-assisted ENB for lung nodule biopsy were prospectively enrolled. ENB was performed followed by digital tomosynthesis correction. Once optimal F-ENB alignment was achieved, and a needle was advanced into the expected location of the nodule followed by CBCT. The primary outcome was the percentage of “needle-in-lesion” hits, defined as needle tip within the nodule in 3 planes. Secondary outcomes were diagnostic yield, procedure and room time, complications, radiation, and distance between the needle tip and nodule. Results: Twenty-six patients with a total of 29 nodules were enrolled. Mean nodule size was 13 mm (±4 mm) in maximal axial dimension, 83% (n = 24) were located in the peripheral third of the chest, and 17% (n = 5) had a bronchus sign. F-ENB guidance resulted in needle-in-lesion in 21 of 29 nodules (72%). Mean needle tip-to-nodule distance for nonhits was 1.75 mm (±1.35 mm). There were no complications. Conclusion: F-ENB resulted in a needle-in-lesion biopsy in greater than 70% of nodules despite features traditionally associated with poor diagnostic yield (size, absence of bronchus sign). Mean distance between needle tip and target for nonhits was less than 2 mm. These data suggest F-ENB alignment is accurate for small peripheral nodules.

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Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran’s Affairs Hospital

Journal of Clinical Medicine ◽

10.3390/jcm10163671 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3671

Author(s):

Chigozirim N. Ekeke ◽

Matthew Vercauteren ◽

Smiljana Istvaniczdravkovic ◽

Roy Semaan ◽

Rajeev Dhupar

Keyword(s):

Clinical Utility ◽

Diagnostic Yield ◽

Lung Nodule ◽

Pulmonary Nodules ◽

Subsequent Treatment ◽

Diagnostic Tools ◽

Lung Nodules ◽

Robotic Assisted ◽

The Right ◽

Electromagnetic Navigational Bronchoscopy

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.

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