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Shaller BD, Gildea TR. What is the value of electromagnetic navigation in lung cancer and to what extent does it require improvement? Expert Rev Respir Med 2020; 14:655-669. [DOI: 10.1080/17476348.2020.1748012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Brian D. Shaller
- Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas R. Gildea
- Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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2
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Abstract
With the advent of lung cancer screening, and the increasingly frequent use of computed tomography (CT) scanning for investigating non-pulmonary pathology (for example CT coronary angiogram), the number of pulmonary nodules requiring further investigation has risen significantly. Most of these nodules are found in the lung periphery, which presents challenges to biopsy, and many centers rely on trans-thoracic needle biopsy performed under image guidance by radiologists. However, the desire to minimize complications is driving the development of increasingly accurate navigation bronchoscopy platforms, something that will be crucial in the new era of bronchoscopic therapeutics for lung cancer. This review describes these platforms, summarizes the current evidence for their use, and takes a look at future developments.
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Affiliation(s)
- Samuel Victor Kemp
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom, .,National Heart and Lung Institute, Imperial College, London, United Kingdom,
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Patrucco F, Gavelli F, Daverio M, Antonini C, Boldorini R, Casadio C, Balbo PE. Electromagnetic Navigation Bronchoscopy: Where Are We Now? Five Years of a Single-Center Experience. Lung 2018; 196:721-727. [PMID: 30209566 DOI: 10.1007/s00408-018-0161-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Electromagnetic navigation (ENB) is a guidance tool used in the diagnosis of solitary pulmonary nodules (SPNs) and masses. Its diagnostic yield is highly variable (38-71%) and a recent study has put in doubt the role of ENB in sampling SPNs in a real-life setting. The aim of this study is to describe the 5-year experience of our center with ENB, analyzing the population, possible confounding factors, and the diagnostic yield and accuracy of this technique. METHODS We conducted a retrospective observational study including all consecutive patients who underwent ENB for SPNs and masses from January 2011 to December 2015. RESULTS We included 113 patients; 79% had SPNs, 21% masses. The majority were localized in the upper and middle lobes (80%) and 61% presented a bronchus sign. 54% of the patients had a previous negative fluoroscopy-guided bronchoscopy. ENB achieved the diagnosis in 78 patients (69%) with 64 malignant and 14 were benign lesions. The diagnostic yield and accuracy of ENB were respectively 0.69 and 0.76. The only factor influencing the ability to reach a diagnosis was the presence of bronchus sign (p = 0.002). No procedural complications were reported. CONCLUSION ENB is a safe procedure with a similar diagnostic yield in the real-life and research setting. Bronchus sign is an important factor in determining the diagnostic yield. ENB efficacy can be maximized by expertise and by a careful selection of each case.
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Affiliation(s)
- Filippo Patrucco
- Department of Translational Medicine, Pneumology Unit U, University of Piemonte Orientale, Sant'Andrea Hospital, Vercelli, Italy. .,Division of Respiratory Medicine, Medical Department, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, C.so Mazzini 18, 28100, Novara, Italy.
| | - Francesco Gavelli
- Department of Translational Medicine, Emergency Medicine Unit, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Matteo Daverio
- Division of Respiratory Medicine, Medical Department, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, C.so Mazzini 18, 28100, Novara, Italy
| | - Cleto Antonini
- Department of Emergency Acceptance, Anaesthesia and Intensive Care, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Renzo Boldorini
- Department of Translational Medicine, Pathology Unit, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Caterina Casadio
- Surgical Department, Thoracic Surgery Unit, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Piero E Balbo
- Division of Respiratory Medicine, Medical Department, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, C.so Mazzini 18, 28100, Novara, Italy
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Kumar A, Dhillon SS, Patel S, Grube M, Noheria A. Management of cardiac implantable electronic devices during interventional pulmonology procedures. J Thorac Dis 2017; 9:S1059-S1068. [PMID: 29214065 DOI: 10.21037/jtd.2017.07.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increasing number of patients are receiving cardiac implantable electronic devices (CIED) now. Many of them need pulmonary procedures for various indications including, but not limited to, lung cancer and benign endobronchial lesions. Over the last two decades, interventional pulmonology (IP) has expanded its scope to include various modalities that use heat and electrical energy and in the process, create electromagnetic field in the vicinity. This raises concerns for electromagnetic interference (EMI) causing abnormal behavior in the CIEDs. While guidelines and recommendations on the peri-procedural management of CIEDs do exist, none of them directly address the pulmonary procedures. In this paper, we strive to review the available literature pertaining to the management of CIEDs in the context of EMI caused by the various IP procedures.
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Affiliation(s)
- Abhishek Kumar
- Department of Pulmonary Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Samjot Singh Dhillon
- Department of Medicine, Pulmonary and Critical Care, Roswell Park Cancer Institute/University at Buffalo, Buffalo, NY, USA
| | - Spandan Patel
- Hospitalist Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Matthias Grube
- Cardiothoracic Anesthesiology Fellow, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit Noheria
- Cardiovascular Electrophysiology, Washington University School of Medicine, St. Louis, MO, USA
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5
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Abstract
Peripheral pulmonary lesions (PPLs) are generally considered as lesions in the peripheral one-third of the lung although a precise definition and radiographic anatomical landmarks separating central and peripheral lesion does not yet exist. The radiographic detection of such lesions has increased significantly with the adoption of lung cancer screening programs. These lesions are not directly visible by regular flexible bronchoscopes as they are usually distal to the lobar and segmental bronchi. Traditionally, depending on location and clinical stage at presentation, these lesions were typically sampled by computerized tomography (CT) guided needle or surgical biopsy although some centers also used ultrasound and fluoroscopy guided percutaneous needle biopsy. Due to lack of direct visualization, the yield for bronchoscopic guided sampling especially of the small <2 cm pulmonary nodules was very low. Therefore, sampling has been preferentially performed by percutaneous CT guidance, which had high yield of above 90% but it comes at the cost of higher risk complications like pneumothorax with reported rate of 15% to 28%. Directly proceeding to surgical resection is also considered in appropriate candidates with high suspicion of malignancy without any evidence of distant metastasis but the proportion of such cases of lung cancer is low. The manuscript discussed the various bronchoscopic diagnostic modalities for peripheral pulmonary lesions. It is important to note that most of the studies in this field are relatively small, not randomized, suffer from selection bias, have considerable heterogeneity in sampling methodology/instruments and usually have been performed in high volume institutions by dedicated highly experienced proceduralists. The prevalence of malignancy in most of the reported cohorts has also been high which may result in higher diagnostic yields. All these factors need to be kept in mind before generalizing the results to individual centers and practices.
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Affiliation(s)
- Samjot Singh Dhillon
- Division of Pulmonary Medicine and Interventional Pulmonology, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kassem Harris
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, Westchester Medical Center, Valhalla, NY, USA
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Malagù M, Ferri A, Mancuso O, Trevisan F, Nardozza M, Bertini M. Implantable cardioverter defibrillator management: an update. Future Cardiol 2016; 12:673-688. [PMID: 27762625 DOI: 10.2217/fca-2016-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.
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Affiliation(s)
- Michele Malagù
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Alessandra Ferri
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Ottavia Mancuso
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Filippo Trevisan
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Marianna Nardozza
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Matteo Bertini
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
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Corzani A, Ziacchi M, Biffi M, Allaria L, Diemberger I, Martignani C, Bratten T, Gardini B, Boriani G. Clinical management of electromagnetic interferences in patients with pacemakers and implantable cardioverter-defibrillators: review of the literature and focus on magnetic resonance conditional devices. J Cardiovasc Med (Hagerstown) 2016; 16:704-13. [PMID: 26313816 DOI: 10.2459/jcm.0000000000000301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The number of cardiac implantable electronic devices (CIEDs) has greatly increased in the last 10 years. Many electronic devices used in daily activities generate electromagnetic interferences (EMIs) that can interact with CIEDs. In clinical practice, it is very important to know the potential sources of EMIs and their effect on CIEDs in order to understand how to manage or mitigate them. A very important source of EMI is magnetic resonance (MR), which is considered nowadays the diagnostic gold standard for different anatomical districts. In this review, we focused on the effects of EMI on CIEDs and on the clinical management. Moreover, we made a clarification about MR and CIEDs.In patients with CIEDs, EMIs may cause potentially serious and even life-threatening complications (inappropriate shocks, device malfunctions, inhibition of pacing in pacemaker-dependent patients) and may rarely dictate device replacement. The association of inappropriate shocks with increased mortality highlights the importance of minimizing the occurrence of EMI. Adequate advice and recommendations about the correct management of EMIs in patients with CIEDs are required to avoid all complications during hospitalization and in daily life. Furthermore, the article focused on actual management about MR and CIEDs.
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Affiliation(s)
- Alessandro Corzani
- aDepartment of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola Malpighi University Hospital, Bologna, Italy bMedtronic Inc, Minneapolis, Minnesota, USA *These authors contributed equally to this work
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