Efficacy and safety of virtual bronchoscopic navigation with fused fluoroscopy and vessel mapping for access of pulmonary lesions

Abstract

Background and objective Virtual bronchoscopic navigation (VBN) with fused fluoroscopy and vessel mapping provides a point of entry (POE) for puncturing airway wall to biopsy lesions. The study was designed to evaluate the safety and efficacy of this technology to diagnose peripheral pulmonary lesions. Methods It was a prospective, single‐arm, multicentre study. Patients underwent lesions biopsy with the Archimedes® VBN System via a POE using one of the two techniques: (1) bronchoscopic transparenchymal nodule access (BTPNA) and (2) guided transbronchial needle aspiration (TBNA). Biopsy yield, sampling yield and diagnostic yield were mainly determined in lesions biopsy attempted. Results One hundred and thirty patients underwent anaesthesia and constituted the intention‐to‐treat population. One hundred and four patients with 114 lesions had biopsy attempted. Mean lesion size was 2.4 ± 1.13 cm. Sufficient tissue samples were obtained from 86 lesions with a biopsy yield of 75.4%. Nevertheless, sufficient samples for diagnosis based on histology ± cytology were obtained from 107 lesions with a sampling yield of 93.9%. Follow‐up was conducted for more than 1 year, with a diagnostic yield of 75.4% and 72.8%, respectively, on high and low estimate with consideration of three lesions without follow‐up. Two (1.9%) pneumothoraxes and one (1.0%) mild bleeding occurred. Conclusion BTPNA and guided TBNA contribute to safe and effective sampling of peripheral pulmonary lesions. A relatively high biopsy yield was obtained independent of the presence or absence of a bronchus sign (BS), and high sampling yield and diagnostic yield were obtained independent of location, lesion size and presence or absence of a BS.

The Feasibility of Using the “Artery Sign” for Pre-Procedural Planning in Navigational Bronchoscopy for Parenchymal Pulmonary Lesion Sampling

“…Sun et al demonstrated the efficacy and safety profile of using fused fluoroscopy and vessel mapping to aid with virtual bronchoscopic navigation and pulmonary lesion sampling. The avoidance of virtually mapped blood vessels during transparenchymal nodule sampling may have contributed to their low rate of airway bleeding [ 20 ]. This may be clinically relevant, especially when sampling pulmonary lesions that are central and adjacent to larger pulmonary vessels.…”

Application of Bronchoscopic TransParenchymal Nodule Access in tuberculous bronchial occlusion

“…In this process, the C‐arm + X‐ray also indirectly guides the correct puncture direction of the FlexNeedle needle, reducing the risk of the operation and improving the success rate of the operation. Based on CT scan, Archimedes magnetic navigation imaging software virtual left main bronchus images before and after patency 20 and further evaluated the changes of left main bronchus after silicone stent implantation.…”

Cone-beam CT in lung biopsy: a clinical practice review on lessons learned and future perspectives

“…And on top of updates in pre-existing technologies such as EMN, several novel navigation bronchoscopy technologies have been introduced with the potential to further improve diagnostic yield. New kids on the block that aim to help diagnose peripheral pulmonary nodules now include specialized navigation instruments (21), robotics (22)(23)(24)(25)(26), cone beam CT (CBCT) (27)(28)(29)(30), mobile 3D C-arm imaging (31,32) and hybrid methods that combine modalities for navigation guidance and confirmation (33,34).…”