Lonny Yarmus1, Jason Akulian2, Momen Wahidi3, Alex Chen4, Jennifer P Steltz5, Sam L Solomon5, Diana Yu6, Fabien Maldonado7, Jose Cardenas-Garcia8, Daniela Molena9, Hans Lee10, Anil Vachani11. 1. Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: lyarmus@jhmi.edu. 2. Division of Pulmonary and Critical Care, University of North Carolina School of Medicine, Chapel Hill, NC. 3. Division of Pulmonary and Critical Care, Duke University School of Medicine, Durham, NC. 4. Division of Pulmonary and Critical Care, Washington University of St. Louis School of Medicine, St. Louis, MO. 5. Division of Pulmonary and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA. 6. Division of Pulmonary and Critical Care, Stanford University School of Medicine, Stanford, CA. 7. Division of Pulmonary and Critical Care, Vanderbilt University School of Medicine, Nashville, TN. 8. Division of Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor, MI. 9. Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 10. Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD. 11. Division of Pulmonary and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA; Division of Pulmonary and Critical Care, University of Pennsylvania School of Medicine, and the Corporal Michael J. Crescenz VA Medical Center Philadelphia, PA.
Abstract
BACKGROUND: The capability of bronchoscopy in the diagnosis of peripheral pulmonary nodules (PPNs) remains limited. Despite decades of effort, evidence suggests that the diagnostic accuracy for electromagnetic navigational bronchoscopy (EMN) and radial endobronchial ultrasound (EBUS) approach only 50%. New developments in robotic bronchoscopy (RB) may offer improvements in the assessment of PPNs. METHODS: A prospective single-blinded randomized controlled comparative study to assess success in localization and puncture of PPNs, using an ultrathin bronchoscope with radial EBUS (UTB-rEBUS) vs EMN vs RB in a human cadaver model of PPNs < 2 cm, was performed. The primary end point was the ability to successfully localize and puncture the target nodule, verified by cone-beam CT comparing RB and EMN. Secondary end points included needle to target position "miss" distance, and UTB-rEBUS comparisons. RESULTS: Sixty procedures were performed to target 20 PPNs over the study period. Implanted PPNs were distributed across all lobes, with 80% located within the lung periphery. The target PPN mean diameter was 16.5 ± 1.5 mm, with 50% noted to have a CT bronchus sign. The rate of successful PPN localization and puncture was superior when using RB, compared with EMN (80% vs 45%; P = .02). Among unsuccessful needle passes, the median needle to target "miss" distance was significantly different when comparing UTB-rEBUS, EMN, and RB (P = .0014). CONCLUSIONS: In a cadaver model, use of RB significantly increased the ability to localize and successfully puncture small PPNs when compared with existing technologies. This study demonstrates the potential of RB to precisely reach, localize, and puncture small nodules in the periphery of the lung.
RCT Entities:
BACKGROUND: The capability of bronchoscopy in the diagnosis of peripheral pulmonary nodules (PPNs) remains limited. Despite decades of effort, evidence suggests that the diagnostic accuracy for electromagnetic navigational bronchoscopy (EMN) and radial endobronchial ultrasound (EBUS) approach only 50%. New developments in robotic bronchoscopy (RB) may offer improvements in the assessment of PPNs. METHODS: A prospective single-blinded randomized controlled comparative study to assess success in localization and puncture of PPNs, using an ultrathin bronchoscope with radial EBUS (UTB-rEBUS) vs EMN vs RB in a human cadaver model of PPNs < 2 cm, was performed. The primary end point was the ability to successfully localize and puncture the target nodule, verified by cone-beam CT comparing RB and EMN. Secondary end points included needle to target position "miss" distance, and UTB-rEBUS comparisons. RESULTS: Sixty procedures were performed to target 20 PPNs over the study period. Implanted PPNs were distributed across all lobes, with 80% located within the lung periphery. The target PPN mean diameter was 16.5 ± 1.5 mm, with 50% noted to have a CT bronchus sign. The rate of successful PPN localization and puncture was superior when using RB, compared with EMN (80% vs 45%; P = .02). Among unsuccessful needle passes, the median needle to target "miss" distance was significantly different when comparing UTB-rEBUS, EMN, and RB (P = .0014). CONCLUSIONS: In a cadaver model, use of RB significantly increased the ability to localize and successfully puncture small PPNs when compared with existing technologies. This study demonstrates the potential of RB to precisely reach, localize, and puncture small nodules in the periphery of the lung.
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Authors: Christopher M Kapp; Jason A Akulian; Diana H Yu; Alexander Chen; José Cárdenas-García; Daniela Molena; Anil Vachani; Momen M Wahidi; Fabien Maldonado; David Fielding; Lonny B Yarmus; Hans Lee Journal: ATS Sch Date: 2020-12-23