The Effect of Respiratory Motion on Pulmonary Nodule Location During Electromagnetic Navigation Bronchoscopy

Chen, Alexander; Pastis, Nicholas J.; Furukawa, Brian; Silvestri, Gerard A.

doi:10.1378/chest.14-1425

Cited by 117 publications

(102 citation statements)

References 11 publications

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“…This divergence has been hypothesized to explain, among other factors, the generally disappointing yields on navigational bronchoscopy. Some proposed causes of divergence include lung volume differences at the time of planning CT and the procedure, general anaesthesia and development of atelectasis …”

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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“…Fluoroscopic guidance was used in 100% of ENB procedures in our study. ENB using superDimension does not allow respiratory gating as 30-40% of nodules move >2cm in upper lobes and >4cm in lower lobes with diaphragmatic excursion [Chen et al 2015]. Therefore using fluoroscopic guidance allows for better navigation.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic yield for lesions in the lower lobes in our study was also comparatively lower (right lower lobe 57%, left lower lobe 40% versus right upper lobe 62% and left upper lobe 70%). Moreover, the location of pulmonary lesions on full inspiratory planning chest CT does not reflect the actual position of these lesions at the time of bronchoscopy [Chen et al 2015].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of electromagnetic navigational bronchoscopy

Al-Jaghbeer

Marcus

Durkin

et al. 2016

Ther Adv Respir Dis

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Objectives: Peripheral lung nodules (PLNs) are a common and diagnostically challenging finding. Electronavigational bronchoscopy (ENB) is used to increase the diagnostic yield and is considered safe. Multiple factors have been correlated with a better diagnostic yield. We sought to assess the effect of nodule characteristics and prior workup on the diagnostic yield in ENB. Methods: This was a retrospective chart review of 98 ENB procedures in a community referral center. Two investigators reviewed patients' charts and images independently. Multiple logistic regression analyses was used to determine if factors such as bronchus sign, ground glass opacification (GGO), distance from pleura, prior use of endobronchial ultrasound (EBUS) and positron emission tomography (PET) had an impact on the diagnostic yield. Results: We evaluated 98 ENBs performed in 92 patients. Most of the lesions were in the upper lobes. The diagnostic yield was 60%. A PET scan was performed prior to ENB in 47% of cases. EBUS was performed in 24% of cases. Bronchus sign was present in 60% of cases and GGO in only 6% of nodules. The odds ratio for diagnostic yield with a bronchus sign was 1.89 [95% confidence interval (CI): 0.83-4.33] and with nodules showing GGO characteristics it was 4.51 (95% CI: 0.51-39.68). Pneumothorax occurred in 6% of cases. Conclusion: In our cohort, diagnostic yield was 60% with a 6% pneumothorax rate. A suggestive trend for the presence of bronchus sign on computed tomography scan, albeit statistically nonsignificant, as a predictor for improved diagnostic yield needs to be validated in a larger cohort.

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“…Actually, one of the main challenges for us is hard to find the exact position to perform a biopsy for the lesion located in the lower lobe when respiratory motion. According to the other studies, this movement during bronchoscopy may even significantly affect the diagnostic yield of electromagnetic navigation bronchoscopy procedures [20]. The lesion size and distance from the pleura doesn’t significantly impact the movement.…”

Section: Discussionmentioning

confidence: 99%

Small lung lesions invisible under fluoroscopy are located accurately by three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields

Deng

Cao²,

et al. 2016

BMC Pulm Med

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BackgroundNowadays, small peripheral pulmonary lesions (PPLs) are frequently detected and the prognosis of lung cancer depends on the early diagnosis. Because of the high fee and requiring specialized training, many advanced techniques are not available in many developing countries and rural districts.MethodsThree sets of opaque soft copper wires visible under the fluoroscopy (Flu) in the Flu-flexible bronchoscopy (FB) group (n = 24), which determined the three planes of the lesion, were respectively placed firmly on the surface of the chest wall with adhesive tape on the chest wall. The FB tip was advanced into the bronchus toward the crosspoint of the three perpendicular planes under Flu with careful rotation of a C-arm unit. Then the specimen were harvested focusing around the crosspoint for pathologic diagnosis. The rapid on-site evaluation (ROSE) procedure was also performed. The average Flu time during FB procedures were recorded and diagnostic accuracy rates in the Flu-FB group were compared with the other group guided by radial endobronchial ultrasound (R-EBUS) (n = 23).ResultsThe location of the core point of the lesion, whether it was visible or not under the fluoroscopy could be recognized by three-dimensional localization technique. The accuracy rates of diagnostic yields were 62.5% in the Flu-FB group, and was similar as 65.2% in the R-EBUS group (P > 0.05). However, in the Flu-FB group, there was a decreasing tendency on accurate diagnosis rates of lower lobe (LL) lesions when comparing with non-LL lesions (3/8 = 37.5% vs 12/16 = 75%, P = 0.091) while in the R-EBUS group it was similar (9/12 = 75% vs 6/11 = 54.6%, P = 0.278). In the Flu-FB group, fluoroscopy time was negatively correlated with the lesion length (r = −0.613, P = 0.001), however, there was no significant difference between the lesions invisible or not (5.83 ± 1.45 min vs 7.67 ± 2.02 min, P = 0.116) under the fluoroscopy, as well as no significant difference among SPN, mGGO and GGO (6.12 ± 2.05 min, 7.25 ± 1.33 min and 7.80 ± 2.02 min, P > 0.05).ConclusionsSmall PPL whether it is visible or not under fluoroscopy can be located accurately by our three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields. It is more convenient, economical and reliable with the similar diagnostic yields than R-EBUS guided method.Trial registrationCurrent Controlled Trials ChiCTR-DDD-16009715. The date of registration: 3rd Nov, 2016. Retrospectively registered.

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The Effect of Respiratory Motion on Pulmonary Nodule Location During Electromagnetic Navigation Bronchoscopy

Cited by 117 publications

References 11 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

Diagnostic yield of electromagnetic navigational bronchoscopy

Small lung lesions invisible under fluoroscopy are located accurately by three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields

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