Bronchoscopic transparenchymal nodule access in the diagnosis and management of pulmonary nodules

Abstract

To the Editor: Transthoracic needle aspiration (TTNA) and bronchoscopy have been the preferred methods for the sampling of pulmonary nodules suspected of lung cancer. However, despite having a higher diagnostic accuracy, TTNA has been associated with a high rate of pneumothorax. Moreover, conventional bronchoscopy with a low rate of pneumothorax has exhibited a low diagnostic yield for peripheral pulmonary nodules, particularly for nodules <2 cm in size or those without a bronchus leading directly to them. Thus, Herth et al [1] developed a novel bronchoscopy technique called bronchoscopic transparenchymal nodule access (BTPNA) under the guidance of Archimedes Virtual Bronchoscopic Navigation (VBN) System for the purpose of accessing pulmonary nodules using a transparenchymal approach without relying on the airway to approach the lesion. Here, we systematically reviewed evidence regarding BTPNA to provide general guidance on the safe implementation and development of this novel approach.