Sight Unseen: Diagnostic Yield and Safety Outcomes of a Novel Multimodality Navigation Bronchoscopy Platform with Real-Time Target Acquisition

Avasarala, Sameer K.; Roller, Lance; Katsis, James; Chen, Heidi; Lentz, Robert J.; Rickman, Otis B.; Maldonado, Fabien

doi:10.1159/000518009

Cited by 21 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Throughout procedure, it provides real time confirmation that the catheter is aligned to the nodule, and this alignment can be maintained even after the LG is removed, owing to the presence of sensor coils embedded in the tip of EWC. This continuous positional data allows for multidirectional sampling and more thorough biopsy, as have been demonstrated in biopsy series using this platform ( 7 , 8 ).…”

Section: Discussionmentioning

confidence: 88%

Electromagnetic navigation bronchoscopy transbronchial lung nodule ablation with IllumisiteTM platform corrects CT-to-body divergence with tomosynthesis and improves ablation workflow: a case report

Chan¹,

Chang²,

Siu³

et al. 2023

AME Case Rep

View full text Add to dashboard Cite

Background Transbronchial ablation of lung nodules is gaining popularity as part of lung-preserving strategy for patients with multifocal lung cancers or multiple lung oligometastases. Accuracy in placement of ablation catheter is of utmost importance in order to achieve adequate ablation margin. However, older systems are not precise enough for confident placement of ablation catheter and often require multiple cone-beam CT (CBCT) to confirm and readjust its position. The following case is the first microwave lung ablation utilizing the novel Illumisite TM platform (Medtronic, Minneapolis, MN, USA) in the hybrid operating room (HOR), with enhanced accuracy and workflow. Case Description A 66-year-old lady had multiple resected adenocarcinomas in bilateral lungs. Upon CT monitoring a right middle lobe (RML) ground glass opacity with solid centre was found to be suspicious due to increasing size and density. Transbronchial electromagnetic navigation bronchoscopy (ENB) microwave ablation of the lesion was performed as part of lung-conserving strategy. After initial navigation, the adjusted nodule position provided by the IllumisiteTM platform after correcting the CT-to-body divergence prompted operators to renavigate and readjust the position of the locatable guide (LG) swiftly to gain accurate access to the nodule, which was confirmed by CBCT. Positional data at the tip of extended working channel (EWC) also allowed precise placement of needle for subsequent ablation. Conclusions Illumisite TM is a novel electromagnetic navigational platform that corrects for CT-to-body divergence and ensures continuous locational information by an additional positional coil in the tip of EWC. This precision is especially important for the placement of ablation catheter, as slight deviation would lead to insufficient ablation margin and future recurrence. Workflow is improved by reducing the number of CBCT required for instrument position adjustment.

show abstract

Section: Discussionmentioning

confidence: 88%

Electromagnetic navigation bronchoscopy transbronchial lung nodule ablation with IllumisiteTM platform corrects CT-to-body divergence with tomosynthesis and improves ablation workflow: a case report

Chan¹,

Chang²,

Siu³

et al. 2023

AME Case Rep

View full text Add to dashboard Cite

show abstract

“…Also, Medtronic developed in the meantime a new ENB platform called illumisite™. This platform uses tomosynthesis to correct the virtual target reducing the discrepancy between the static CT scan and the dynamic breathing lung, enhancing the visibility of the nodule on X-ray fluoroscopy, and allowing to locally register the nodule and adjust alignment during the procedure [ 17 , 18 ]. Accordingly, Aboudara and colleague showed in a retrospective study on 168 cases a diagnostic yield of 79% using the illumisite™ platform compared to 54% with the SuperDimension one [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

High diagnostic yield of electromagnetic navigation bronchoscopy performed under cone beam CT guidance: results of a randomized Belgian monocentric study

et al. 2023

View full text Add to dashboard Cite

Background With the increasing use of low dose CT scans, numerous pulmonary nodules are detected. As majority of them are benign, development of efficient non-surgical diagnostic intervention is mandatory. Electromagnetic navigation bronchoscopy (ENB) has been developed to reach difficult to access lesions. The aim of the present study was to compare the diagnostic yield of ENB procedures performed in a classical endoscopy suite or in a hybrid room equipped by a cone beam CT (CBCT). Methods A monocentric randomized study was performed in the Erasme Hospital between January 2020 and December 2021. Lung nodules of maximum 30 mm of diameter were eligible. In both arms (endoscopy or CBCT suites), ENB, fluoroscopic guidance and a radial endobronchial ultrasound were used to reach the lesion. Then six trans-bronchial biopsies (TBB) and one trans-bronchial lung cryobiopsy (TBLC) were performed. Primary outcomes were the diagnostic yield and diagnostic accuracy of the procedure. Results Forty-nine patients were randomized (24 in the endoscopy and 25 in the CBCT arms). The lesion size was 15,9 ± 4,6 mm and 16,6 ± 6,0 mm respectively (mean ± SD, p = NS). The diagnostic yield of ENB performed under CBCT guidance was 80% compared to 42% when performed in the endoscopy suite under standard fluoroscopic guidance (p < 0,05). Similarly, the diagnostic accuracy in the CBCT group was 87% compared to 54% for the endoscopy group (p < 0,05). Duration of the procedure in the CBCT and endoscopy arms was 80 ± 23 and 61 ± 13 min respectively (mean ± SD, p < 0,01). Performing TBLC in addition to TBB increased the diagnostic yield by 14% (17 and 12,5% in CBCT and endoscopy suites respectively, p = NS). Conclusion This study highlighted the additional value to perform ENB procedure under CBCT guidance for small size (less than 2 cm of diameter) pulmonary nodules. Trial registration Clinical trial registration number: NCT05257382.

show abstract

“…Inaccurate navigation from CT-to-body divergence can lead to excessive CBCT requirement and instrument re-navigation [112][113]. To reduce the CT-to-body divergence, innovative navigation systems such as Illumisite and Galaxy robotic bronchoscopy platforms utilize integrated fluoroscopic technology and tomosynthesis-based navigation correction to provide continuous positional information of the lesion position and real-time catheter position confirmation, thus reduce reliance on CBCT or need for instrumental re-positioning [114][115][116]. A randomized trial -the RELIANT trial comparing the diagnostic yield of the Ion ENB platform and the Illumisite RAB platform is currently in progress [117], and these technologies are highly anticipated to enhance the applicability in BMWA [118].…”

Section: Future Innovationsmentioning

confidence: 99%

Treatment strategies for malignant pulmonary nodule: beyond lobectomy. Point-counterpoint

Chang,

Ng,

Nezami

2023

Current Opinion in Pulmonary Medicine

View full text Add to dashboard Cite

Purpose of review Technological advancement in low-dose computed tomography resulted in an increased incidental discovery of early-stage lung cancer and multifocal ground glass opacity. The demand for parenchyma-preserving treatment strategies is greater now than ever. Pulmonary ablative therapy is a groundbreaking technique to offer local ablative treatment in a lung-sparing manner. It has become a promising technique in lung cancer management with its diverse applicability. In this article, we will review the current development of ablative therapy in lung and look into the future of this innovative technique. Recent findings Current literature suggests that ablative therapy offers comparable local disease control to other local therapies and stereotactic body radiation therapy (SBRT), with a low risk of complications. In particular, bronchoscopic microwave ablation (BMWA) has considerably fewer pleural-based complications due to the avoidance of pleural puncture. BMWA can be considered in the multidisciplinary treatment pathway as it allows re-ablation and allows SBRT after BMWA. Summary With the benefits which ablative therapy offers and its ability to incorporate into the multidisciplinary management pathway, we foresee ablative therapy, especially BMWA gaining significance in lung cancer treatment. Future directions on developing novel automated navigation platforms and the latest form of ablative energy would further enhance clinical outcomes for our patients.

show abstract

Sight Unseen: Diagnostic Yield and Safety Outcomes of a Novel Multimodality Navigation Bronchoscopy Platform with Real-Time Target Acquisition

Cited by 21 publications

References 27 publications

Electromagnetic navigation bronchoscopy transbronchial lung nodule ablation with IllumisiteTM platform corrects CT-to-body divergence with tomosynthesis and improves ablation workflow: a case report

Electromagnetic navigation bronchoscopy transbronchial lung nodule ablation with IllumisiteTM platform corrects CT-to-body divergence with tomosynthesis and improves ablation workflow: a case report

High diagnostic yield of electromagnetic navigation bronchoscopy performed under cone beam CT guidance: results of a randomized Belgian monocentric study

Treatment strategies for malignant pulmonary nodule: beyond lobectomy. Point-counterpoint

Contact Info

Product

Resources

About