Abstract
Introduction: Technology such as electromagnetic navigation technology (EMN) or radial EBUS mini probes (r-EBUS) have helped greatly in gaining access to peripheral pulmonary lesions, but reported pooled yield remains around 70%. An even lower diagnostic yield is reported in lesions <2cm. In this prospective trial, we evaluated if addition of cone beam CT (CBCT) could be of added value to EMN and r-EBUS in increasing diagnostic yield.
Methods: All patients who had an indication for diagnosis of their peripheral pulmonary lesion were included. No pre-selection by means of nodule characteristics were made. 38 Patients (42 nodules) were included and had a navigation bronchoscopy in the hybrid operating room with Siemens Artis Zeego installed (Dec. 2017 – Jan. 2019). The procedure started with EMN and r-EBUS navigation alone, after which verification of navigation accuracy was performed using CBCT imaging. If CBCT imaging showed an inaccurate position of the catheter, subsequent repositioning and consecutive navigation was performed using CBCT guidance and live 3D lesion and pathway augmentation on fluoroscopy.
Results: Mean max. nodule size was 11.5mm (range 4-33 mm). A bronchus sign was seen in 71.4% of cases. EMN combined with r-EBUS alone was successful in 47% of cases. A slight repositioning by CBCT was needed to obtain 58% navigation success. Live 3D-CBCT guidance was needed in all other cases, resulting in a combined navigation success of 88%. The diagnostic yield was however lower, being 71.1%.
Conclusion: Cone beam CT is of added value to EMN and r-EBUS for navigating to small peripheral lung lesions endobronchially and by means of trans-parenchymal access.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA3116.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019