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

Respiration ◽  
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

<b><i>Background:</i></b> 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. <b><i>Objective:</i></b> This study intends to determine the accuracy of F-ENB as confirmed by cone-beam computed tomography (CBCT) scan. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> Twenty-six patients with a total of 29 nodules were enrolled. Mean nodule size was 13 mm (±4 mm) in maximal axial dimension, 83% (<i>n</i> = 24) were located in the peripheral third of the chest, and 17% (<i>n</i> = 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. <b><i>Conclusion:</i></b> 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.

scholarly journals Role of Computed Tomography-guided Biopsies in the Era of Electromagnetic Navigational Bronchoscopy: A Retrospective Study of Factors Predicting Diagnostic Yield in Electromagnetic Navigational Bronchoscopy and Computed Tomography Biopsies

2020 ◽  
Vol 10 ◽  
pp. 33
Author(s):  
Naomi K. Atkins ◽  
Jasraj Marjara ◽  
Jussuf T. Kaifi ◽  
Jeffrey R. Kunin ◽  
Sachin S. Saboo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Yield ◽  
New Technology ◽  
High Risk Population ◽  
Ct Guided ◽  
Lung Lesions ◽  
High Diagnostic Yield ◽  
Bronchoscopic Biopsy ◽  
Ct Guided Biopsy ◽  
Electromagnetic Navigational Bronchoscopy

Objectives: Over 25% of the high-risk population screened for lung cancer have an abnormal computed tomography (CT) scan. Conventionally, these lesions have been biopsied with CT guidance with a high diagnostic yield. Electromagnetic navigational bronchoscopy (ENB) with transbronchial biopsy has emerged as a technology that improves the diagnostic sensitivity of conventional bronchoscopic biopsy. It has been used to biopsy lung lesions, due to the low risk of pneumothorax. It is, however, a new technology that is expensive and its role in the diagnosis of the solitary pulmonary nodule (SPN) is yet to be determined. The purpose of this study was to evaluate the diagnostic yield of CT-guided biopsy (CTB) following non-diagnostic ENB biopsy and identify characteristics of the lesion that predicts a low diagnostic yield with ENB, to ensure appropriate use of ENB in the evaluation of SPN. Materials and Methods: One hundred and thirty-five lung lesions were biopsied with ENB from January 2017 to August 2019. Biopsies were considered diagnostic if pathology confirmed malignancy or inflammation in the appropriate clinical and imaging setting. We evaluated lesions for several characteristics including size, lobe, and central/peripheral distribution. The diagnostic yield of CTB in patients who failed ENB biopsies was also evaluated. Logistic regression was used to identify factors likely to predict a non-diagnostic ENB biopsy. Result: Overall, ENB biopsies were performed in 135 patients with solitary lung lesions. ENB biopsies were diagnostic in 52% (70/135) of the patients. In 23 patients with solitary lung lesions, CTBs were performed following a non-diagnostic ENB biopsy. The CTBs were diagnostic in 87% of the patients (20/23). ENB biopsies of lesions <21.5 mm were non-diagnostic in 71% of cases (42/59); 14 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% of them were diagnostic (12/14). ENB biopsies of lesions in the lower lobes were non- diagnostic in 59% of cases (35/59); 12 of these patients with non-diagnostic ENB biopsies had CTBs, and 83% were diagnostic (10/12). ENB biopsies of lesions in the outer 2/3 were non-diagnostic in 57% of cases (50/87); 21 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% were diagnostic (18/21). Conclusion: CTBs have a high diagnostic yield even following non-diagnostic ENB biopsies. Lesions <21.5 mm, in the outer 2/3 of the lung, and in the lower lung have the lowest likelihood of a diagnostic yield with ENB biopsies. Although CTBs have a slightly higher pneumothorax rate, these lesions would be more successfully diagnosed with CTB as opposed to ENB biopsy, in the process expediting the diagnosis and saving valuable medical resources.

Comparison of digital tomosynthesis and computed tomography for lung nodule detection in SOS screening program

2017 ◽  
Vol 122 (8) ◽  
pp. 568-574 ◽  
Author(s):  
Maurizio Grosso ◽  
◽  
Roberto Priotto ◽  
Donatella Ghirardo ◽  
Alberto Talenti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Screening Program ◽  
Lung Nodule ◽  
Digital Tomosynthesis ◽  
Lung Nodule Detection ◽  
Nodule Detection

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

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.

scholarly journals CT guided lung biopsy: Diagnostic yield and complications, using 18G coaxial semi-automatic core needle

2019 ◽  
Vol 4 (1) ◽  
pp. 20-25
Author(s):  
Ajit Thapa ◽  
Kamal Subedi ◽  
Sundar Suwal ◽  
Dinesh Chataut
Keyword(s):  
Core Biopsy ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Lung Nodule ◽  
Histopathological Diagnosis ◽  
Safe Procedure ◽  
Ct Guided ◽  
Biopsy Needle ◽  
Core Needle ◽  
Clinically Significant

Introduction: CT guided biopsy is essential for histopathological diagnosis of suspicious lung nodule, which are not amenable for either bronchoscopic or sonography guided sampling. Methods: Twenty eight patients with suspicious lung nodules not amenable for bronchoscopic or sonography guided sampling who underwent CT guided lung biopsy with 18 G coaxial semiautomatic core biopsy needle in one year were retrospectively studied for diagnostic yield and complications. Results: Out of 28 patients, who underwent CT guided lung nodule biopsy, 18 were male and 10 were female. The age ranged from 22 to 80 years. Lesion size ranged from one cm to four cm and depth of lesion from pleura ranged from zero cm to five cm. Diagnostic yield of our core needle biopsy was 26(92.3%). Clinically significant complication was low. Massive pneumothorax which needed intercostal drainage was 7.14% (2 patients). Pulmonary hemorrhage manifesting as hemoptysis was seen in 14.3 %( 2 patients). No hemothorax or air embolism was noted in any of the patient. Conclusion: CT guided lung lesion biopsy with 18 G coaxial semi-automatic core biopsy needle is a safe procedure with good diagnostic yield and relatively low incidence of clinically significant complications.

scholarly journals Cone beam CT augmented fluoroscopy allows safe and efficient diagnosis of a difficult lung nodule

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roberto Piro ◽  
Matteo Fontana ◽  
Eleonora Casalini ◽  
Sofia Taddei ◽  
Marco Bertolini ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Yield ◽  
Early Stage ◽  
Lung Nodule ◽  
Lung Cancer Screening ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Lung Nodules ◽  
Proper Position ◽  
Screening Programs

Abstract Background Detection of small peripheral lung nodules is constantly increasing with the development of low dose computed tomography lung cancer screening programs. A tissue diagnosis is often required to confirm malignity, with endobronchial biopsies being associated with a lower pneumothorax rate than percutaneous approaches. Endoscopic diagnosis of peripheral small size lung nodules is however often challenging using traditional bronchoscopy and endobronchial ultrasound alone. New virtual bronchoscopic navigation techniques such as electromagnetic navigational bronchoscopy (ENB) have developed to improve peripheral navigation, with diagnostic yield however remaining in the 30–50% range for small lesions. Recent studies have shown the benefits of combining Cone beam computed tomography (CBCT) with ENB to improve diagnostic yield to up to 83%. The use of ENB however remains limited by disposable cost, bronchus sign dependency and inaccuracies due to CT to body divergence. Case presentation This case report highlights the feasibility and usefulness of CBCT-guided bronchoscopy for the sampling of lung nodules difficult to reach through traditional bronchoscopy because of nodule size and peripheral position. Procedure was scheduled in a mobile robotic hybrid operating room with patient under general anaesthesia. CBCT acquisition was performed to localize the target lesion and plan the best path to reach it into bronchial tree. A dedicated software was used to segment the lesion and the bronchial path which 3D outlines were automatically fused in real time on the fluoroscopic images to augment live guidance. Navigation to the lesion was guided with bronchoscopy and augmented fluoroscopy alone. Before the sampling, CBCT imaging was repeated to confirm the proper position of the instrument into the lesion. Four transbronchial needle aspirations (TBNA) were performed and the tissue analysis showed a primary lung adenocarcinoma. Conclusions CBCT and augmented fluoroscopy technique is a safe and effective and has potential to improve early stage peripheral lesions endobronchial diagnostic yield without ENB. Additional studies are warranted to confirm its safety, efficacy and technical benefits, both for diagnosis of oncological and non-oncological disease and for endobronchial treatment of inoperable patients.

Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Kai-Lun Yu ◽  
Shun-Mao Yang ◽  
Huan-Jang Ko ◽  
Hui-Yu Tsai ◽  
Jen-Chung Ko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Propensity Score ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

<b><i>Background:</i></b> The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated. <b><i>Objectives:</i></b> The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. <b><i>Methods:</i></b> We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety. <b><i>Results:</i></b> While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; <i>p</i> = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; <i>p</i> = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; <i>p</i> = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm<sup>2</sup>, respectively. <b><i>Conclusions:</i></b> TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

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