Michal Jan Sobieszczyk1, Zhuhui Yuan2, Wei Li2, William Krimsky3. 1. Department of Pulmonary and Critical Care Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA. 2. Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China. 3. Department of Pulmonary and Critical Care Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.
Abstract
BACKGROUND: Currently there are several techniques for endoscopic diagnosis of parenchymal lung abnormalities. Electromagnetic navigation with or without endobronchial ultrasound for diagnosis of the above has been well described. Bronchoscopic Trans Bronchial Access Tool is a novel endoscopic technique that creates a virtual pathway to the lesion and is less limited by location of the airway. The CrossCountryTM Transbronchial Access Tool (CovidienTM, Plymouth, MN, USA) is a Food and Drug Administration (FDA) approved off airway device that utilizes a catheter equipped guide sheath for a trans-parenchymal approach to a distal lesion. Cone beam computer tomography (CBCT) is a real-time onsite extrathoracic navigational modality used in the bronchoscopy suite that allows for an open working channel. All three of the above modalities can have reasonable diagnostic yields when used independently. While utilizing the above tools we frequently found ourselves in situations where one technique was not enough, prompting the use of a combination of modalities to obtain the most efficient and accurate diagnosis. We are reporting the feasibility and safety of utilizing these three modalities in conjunction with one another. METHODS: Patients with peripheral pulmonary nodules on chest computed tomography underwent a navigation bronchoscopy under general anesthesia. CBCT and radial ultrasound was used in every case to confirm navigation to the target lesion. Lesions without definitive airways leading to them were accessed with the transbronchial access tool (TBAT). RESULTS: Electromagnetic bronchoscopy using CBCT and radial US was performed on 22 patients from April 2016 to September 2016. The TBAT tool was used in 7 patients. The overall diagnostic yield was 77.2% (17 of 22). Diagnostic yield of with use TBAT was 100% (7 of 7). There were no complications. Average case length was 79.95 (range, 50-124) minutes and average fluoroscopy time was 10.39 (1-21.7) minutes. CONCLUSIONS: TBAT is a useful and safe tool when accessing peripheral pulmonary nodules and is used in conjunctions with electromagnetic navigation and CBCT.
BACKGROUND: Currently there are several techniques for endoscopic diagnosis of parenchymal lung abnormalities. Electromagnetic navigation with or without endobronchial ultrasound for diagnosis of the above has been well described. Bronchoscopic Trans Bronchial Access Tool is a novel endoscopic technique that creates a virtual pathway to the lesion and is less limited by location of the airway. The CrossCountryTM Transbronchial Access Tool (CovidienTM, Plymouth, MN, USA) is a Food and Drug Administration (FDA) approved off airway device that utilizes a catheter equipped guide sheath for a trans-parenchymal approach to a distal lesion. Cone beam computer tomography (CBCT) is a real-time onsite extrathoracic navigational modality used in the bronchoscopy suite that allows for an open working channel. All three of the above modalities can have reasonable diagnostic yields when used independently. While utilizing the above tools we frequently found ourselves in situations where one technique was not enough, prompting the use of a combination of modalities to obtain the most efficient and accurate diagnosis. We are reporting the feasibility and safety of utilizing these three modalities in conjunction with one another. METHODS: Patients with peripheral pulmonary nodules on chest computed tomography underwent a navigation bronchoscopy under general anesthesia. CBCT and radial ultrasound was used in every case to confirm navigation to the target lesion. Lesions without definitive airways leading to them were accessed with the transbronchial access tool (TBAT). RESULTS: Electromagnetic bronchoscopy using CBCT and radial US was performed on 22 patients from April 2016 to September 2016. The TBAT tool was used in 7 patients. The overall diagnostic yield was 77.2% (17 of 22). Diagnostic yield of with use TBAT was 100% (7 of 7). There were no complications. Average case length was 79.95 (range, 50-124) minutes and average fluoroscopy time was 10.39 (1-21.7) minutes. CONCLUSIONS: TBAT is a useful and safe tool when accessing peripheral pulmonary nodules and is used in conjunctions with electromagnetic navigation and CBCT.
Authors: D Makris; A Scherpereel; S Leroy; B Bouchindhomme; J-B Faivre; J Remy; P Ramon; C-H Marquette Journal: Eur Respir J Date: 2007-03-14 Impact factor: 16.671
Authors: Wolfgang Hohenforst-Schmidt; Rosemarie Banckwitz; Paul Zarogoulidis; Thomas Vogl; Kaid Darwiche; Eugene Goldberg; Haidong Huang; Michael Simoff; Qiang Li; Robert Browning; Lutz Freitag; J Francis Turner; Patrick Le Pivert; Lonny Yarmus; Konstantinos Zarogoulidis; Johannes Brachmann Journal: J Cancer Date: 2014-02-06 Impact factor: 4.207
Authors: Sandeep J Khandhar; Mark R Bowling; Javier Flandes; Thomas R Gildea; Kristin L Hood; William S Krimsky; Douglas J Minnich; Septimiu D Murgu; Michael Pritchett; Eric M Toloza; Momen M Wahidi; Jennifer J Wolvers; Erik E Folch Journal: BMC Pulm Med Date: 2017-04-11 Impact factor: 3.317
Authors: Wolfgang Hohenforst-Schmidt; Paul Zarogoulidis; Thomas Vogl; J Francis Turner; Robert Browning; Bernd Linsmeier; Haidong Huang; Qiang Li; Kaid Darwiche; Lutz Freitag; Michael Simoff; Ioannis Kioumis; Konstantinos Zarogoulidis; Johannes Brachmann Journal: J Cancer Date: 2014-03-09 Impact factor: 4.207