Cone-Beam CT With Augmented Fluoroscopy Combined With Electromagnetic Navigation Bronchoscopy for Biopsy of Pulmonary Nodules

Pritchett, Michael; Schampaert, S Stéphanie; Groot, Joris A. H. de; Schirmer, Clemens M.; Bom, I van der

doi:10.1097/lbr.0000000000000536

Cited by 155 publications

(167 citation statements)

References 42 publications

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“…While the use of intraoperative cone‐beam CT confirmation might mitigate these issues and provide near real‐time confirmatory imaging, access to cone‐beam technology is limited to a handful of expert centres, and dissemination of the technology will likely be slow . Fluoroscopic ENB (F‐ENB, Medtronic, Minneapolis, MN, USA) is a novel technology that uses digital tomosynthesis technology via a conventional fluoroscopy C‐arm to visualize and re‐register the target nodule based on near real‐time imaging to compensate for divergence.…”

Section: Introductionmentioning

confidence: 99%

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

et al. 2019

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Background and objective The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is inferior to that of computed tomography (CT)‐guided needle biopsy for pulmonary nodules. One explanation for this is divergence between the nodule location on the pre‐procedure CT scan and its actual location during the procedure. Fluoroscopic ENB (F‐ENB) consists of digital tomosynthesis using a conventional C‐arm to re‐register the target lesion based on near real‐time imaging. We performed a retrospective review of ENB cases at our institution before and after introduction of F‐ENB to assess diagnostic yield. Methods All consecutive ENB procedures performed at our institution from 25 December 2017 to 25 August 2018 were reviewed. F‐ENB was introduced on 25 April 2018. Two cohorts were analysed: standard ENB (S‐ENB) from 25 December 2017 to 24 April 2018 and F‐ENB from 25 April 2018 to 25 August 2018. All procedural, demographic and diagnostic data were collected. Descriptive statistics, chi‐square, Wilcoxon test and Student's t‐test were used where appropriate. A multivariable regression analysis was performed to assess factors associated with diagnostic yield. Results A total of 101 and 67 nodules were biopsied in the S‐ENB and F‐ENB groups, respectively. Diagnostic yield was 54% in S‐ENB cohort and 79% in the F‐ENB group (P = 0.0019). Factors independently associated with a positive diagnosis were F‐ENB and a positive radial ultrasound view (odds ratio (OR): 3.57, 95% CI: 1.56–8.18 and OR: 3.74, 95% CI: 1.37–11.05, respectively). Complications were minimal (pneumothorax: 1.5%). Conclusion The use of F‐ENB may increase the diagnostic yield of ENB and has a low complication rate.

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Section: Introductionmentioning

confidence: 99%

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

et al. 2019

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“…Radial endoscopic ultrasound (R-EBUS), fluoroscopy, CT, cone beam CT or a combination of R-EBUS and radiology imaging are used to confirm position prior to sampling. [189][190][191][192][193][194][195][196][197][198] A meta-analysis of R-EBUS showed a pooled sensitivity of 0.72 (95% CI 0.70-0.75). 199 Significant study heterogeneity was noted.…”

Section: Section 6 Diagnostic Methods For Screen-detected Lung Nodulesmentioning

confidence: 99%

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Lam

Bryant

Donahoe

et al. 2020

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…46 A recent retrospective study of 75 consecutive patients reported an overall diagnostic yield of 83.7%. 47 The median lesion size was 16 mm with a range of 7 to 55 mm. No correlation was detected between diagnostic yield and lesion size, location, and visibility under standard fluoroscopy or the presence of a bronchus sign.…”

Section: Bronchoscopic Transparenchymal Nodule Accessmentioning

confidence: 99%

“…The most recent study by Pritchett et al had a pneumothorax rate of 4%. 47 Radiation exposure was evaluated in a subset of nine patients. The mean effective dose was 2 mSV per CBCT scan.…”

Section: Bronchoscopic Transparenchymal Nodule Accessmentioning

confidence: 99%

Lung Nodule Management: An Interventional Pulmonology Perspective

Chaddha

Kurman

Mahajan

et al. 2018

Semin Respir Crit Care Med

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With 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 CT With Augmented Fluoroscopy Combined With Electromagnetic Navigation Bronchoscopy for Biopsy of Pulmonary Nodules

Abstract: Supplemental Digital Content is available in the text.

Cited by 155 publications

References 42 publications

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

Improved diagnostic yield for lung nodules with digital tomosynthesis‐corrected navigational bronchoscopy: Initial experience with a novel adjunct

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

Lung Nodule Management: An Interventional Pulmonology Perspective

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