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Saghaie T, Williamson JP, Phillips M, Kafili D, Sundar S, Hogarth DK, Ing A. First-in-human use of a new robotic electromagnetic navigation bronchoscopic platform with integrated Tool-in-Lesion Tomosynthesis (TiLT) technology for peripheral pulmonary lesions: The FRONTIER study. Respirology 2024. [PMID: 38923084 DOI: 10.1111/resp.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND OBJECTIVE As the presentation of pulmonary nodules increases, the importance of a safe and accurate method of sampling peripheral pulmonary nodules is highlighted. First-generation robotic bronchoscopy has successfully assisted navigation and improved peripheral reach during bronchoscopy. Integrating tool-in-lesion tomosynthesis (TiLT) may further improve yield. METHODS We performed a first-in-human clinical trial of a new robotic electromagnetic navigation bronchoscopy system with integrated digital tomosynthesis technology (Galaxy System, Noah Medical). Patients with moderate-risk peripheral pulmonary nodules were enrolled in the study. Robotic bronchoscopy was performed using electromagnetic navigation with TiLT-assisted lesion guidance. Non-specific results were followed up until either a clear diagnosis was achieved or repeat radiology at 6 months demonstrated stability. RESULTS Eighteen patients (19 nodules) were enrolled. The average lesion size was 20 mm, and the average distance from the pleura was 11.6 mm. The target was successfully reached in 100% of nodules, and the biopsy tool was visualized inside the target lesion in all cases. A confirmed specific diagnosis was achieved in 17 nodules, 13 of which were malignant. In one patient, radiological monitoring confirmed a true non-malignant result. This translates to a yield of 89.5% (strict) to 94.7% (intermediate). Complications included one pneumothorax requiring observation only and another requiring an overnight chest drain. There was one case of severe pneumonia following the procedure. CONCLUSION In this first-in-human study, second-generation robotic bronchoscopy using electromagnetic navigation combined with integrated digital tomosynthesis was feasible with an acceptable safety profile and demonstrated a high diagnostic yield for small peripheral lung nodules.
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Affiliation(s)
- Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin Phillips
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Dona Kafili
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sarika Sundar
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | | | - Alvin Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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2
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Pritchett MA, Williams JC, Schirmer CC, Langereis S. Cone-beam CT-based Navigation With Augmented Fluoroscopy of the Airways for Image-guided Bronchoscopic Biopsy of Peripheral Pulmonary Nodules: A Prospective Clinical Study. J Bronchology Interv Pulmonol 2024; 31:175-182. [PMID: 37759354 DOI: 10.1097/lbr.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Cone-beam computed tomography (CBCT) and augmented fluoroscopy (AF), in which intraprocedural CBCT data is fused with fluoroscopy, have been utilized as a novel image-guidance technique for biopsy of peripheral pulmonary lesions. The aim of this clinical study is to determine the safety and diagnostic performance of CBCT-guided bronchoscopy with advanced software tools for procedural planning and navigational guidance with AF of the airways for biopsy of peripheral pulmonary nodules. METHODS Fifty-two consecutive subjects were prospectively enrolled in the AIRWAZE study (December 2018 to October 2019). Image-guided bronchoscopic biopsy procedures were performed under general anesthesia with specific ventilation protocols in a hybrid operating room equipped with a ceiling-mounted C-arm system. Procedural planning and image-guided bronchoscopy with CBCT and AF were performed using the Airwaze investigational device. RESULTS A total of 58 pulmonary lesions with a median size of 19.0 mm (range 7 to 48 mm) were biopsied. The overall diagnostic yield at index procedure was 87.9% (95% CI: 77.1%-94.0%). No severe adverse events related to CBCT-guided bronchoscopy, such as pneumothorax, bleeding, or respiratory failure, were observed. CONCLUSION CBCT-guided bronchoscopic biopsy with augmented fluoroscopic views of the airways and target lesion for navigational guidance is technically feasible and safe. Three-dimensional image-guided navigation biopsy is associated with high navigational success and a high diagnostic yield for peripheral pulmonary nodules.
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Affiliation(s)
| | | | - Charles C Schirmer
- Pathology, FirstHealth of the Carolinas & Pinehurst Medical Clinic, Pinehurst, NC
| | - Sander Langereis
- Department of Clinical Science IGT-S, Philips Medical Systems, Best, The Netherlands
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3
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Saad F, Frysch R, Saalfeld S, Kellnberger S, Schulz J, Fahrig R, Bhadra K, Nürnberger A, Rose G. Deformable 3D/3D CT-to-digital-tomosynthesis image registration in image-guided bronchoscopy interventions. Comput Biol Med 2024; 171:108199. [PMID: 38394801 DOI: 10.1016/j.compbiomed.2024.108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
Traditional navigational bronchoscopy procedures rely on preprocedural computed tomography (CT) and intraoperative chest radiography and cone-beam CT (CBCT) to biopsy peripheral lung lesions. This navigational approach is challenging due to the projective nature of radiography, and the high radiation dose, long imaging time, and large footprints of CBCT. Digital tomosynthesis (DTS) is considered an attractive alternative combining the advantages of radiography and CBCT. Only the depth resolution cannot match a full CBCT image due to the limited angle acquisition. To address this issue, preoperative CT is a good auxiliary in guiding bronchoscopy interventions. Nevertheless, CT-to-body divergence caused by anatomic changes and respiratory motion, hinders the effective use of CT imaging. To mitigate CT-to-body divergence, we propose a novel deformable 3D/3D CT-to-DTS registration algorithm employing a multistage, multiresolution approach and using affine and elastic B-spline transformation models with bone and lung mask images. A multiresolution strategy with a Gaussian image pyramid and a multigrid strategy within the B-spline model are applied. The normalized correlation coefficient is included in the cost function for the affine model and a multimetric weighted cost function is used for the B-spline model, with weights determined heuristically. Tested on simulated and real patient bronchoscopy data, the algorithm yields promising results. Assessed qualitatively by visual inspection and quantitatively by computing the Dice coefficient (DC) and the average symmetric surface distance (ASSD), the algorithm achieves mean DC of 0.82±0.05 and 0.74±0.05, and mean ASSD of 0.65±0.29mm and 0.93±0.43mm for simulated and real data, respectively. This algorithm lays the groundwork for CT-aided intraoperative DTS imaging in image-guided bronchoscopy interventions with future studies focusing on automated metric weight setting.
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Affiliation(s)
- Fatima Saad
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany.
| | - Robert Frysch
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Jessica Schulz
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Siemens Healthcare GmbH, Forchheim, Germany
| | | | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, USA
| | - Andreas Nürnberger
- Data and Knowledge Engineering Group, Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany
| | - Georg Rose
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
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4
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Patel PP, Duong DK, Mahajan AK, Imai TA. Single Setting Robotic Lung Nodule Diagnosis and Resection. Thorac Surg Clin 2023; 33:233-244. [PMID: 37414479 DOI: 10.1016/j.thorsurg.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Lung cancer remains the leading cause of cancer-related deaths. Early tissue diagnosis followed by timely therapeutic procedures can have a significant impact on overall survival. While robotic-assisted lung resection is an established therapeutic procedure, robotic-assisted bronchoscopy is a more recent diagnostic procedure that improves reach, stability, and precision in the field of bronchoscopic lung nodule biopsy. The ability to combine lung cancer diagnostics with therapeutic surgical resection into a single-setting anesthesia procedure has the potential to decrease costs, improve patient experiences, and most importantly, reduce delays in cancer care.
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Affiliation(s)
- Priya P Patel
- Interventional Pulmonology, Inova Health System, Schar Cancer Institute, 8081 Innovation Park Drive, Suite 3000, Fairfax, VA 22031, USA.
| | - Duy Kevin Duong
- Interventional Pulmonology, Inova Health System, Schar Cancer Institute, 8081 Innovation Park Drive, Suite 3000, Fairfax, VA 22031, USA
| | - Amit K Mahajan
- Interventional Pulmonology, Inova Health System, Schar Cancer Institute, 8081 Innovation Park Drive, Suite 3000, Fairfax, VA 22031, USA
| | - Taryne A Imai
- The Queen's University Medical Group, Queen's Health System, University of Hawaii, 1356 Lusitana Street, 6th floor, Honolulu, HI 96813, USA
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Zhao J, Pu D, Zhang Y, Qu J, Lu B, Cao B. Comparison of Performances of GeneXpert MTB/RIF, Bactec MGIT 960, and Bactec Myco/F Systems in Detecting Mycobacterium tuberculosis in Biopsy Tissues: a Retrospective Study. Microbiol Spectr 2023; 11:e0141422. [PMID: 37154704 PMCID: PMC10269854 DOI: 10.1128/spectrum.01414-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
Tuberculosis remains a major global public concern as a leading cause of health care-associated infections. The detection of Mycobacterium tuberculosis (MTB) is challenging due to the paucibacillary nature of the pathogen. For suspected pulmonary and extrapulmonary tuberculosis patients, if sputum, bronchoalveolar lavage fluid (BALF), related samples are negative for MTB, or suspected tumors, biopsy tissues may provide a better diagnostic yield. This study was aimed at comparing the performances of three methods in identifying MTB in biopsy tissues, including the Bactec mycobacterial growth indicator tube 960 (MGIT 960) system, the GeneXpert MTB/RIF assay (GeneXpert), and the Bactec Myco/F lytic culture (Myco/F) system. Biopsy samples from 3,209 nonduplicated patients were retrospectively enrolled between January 2018 and September 2021, of which 180 (5.6%) were positive for MTB by at least one method. GeneXpert revealed the highest recovery rate (134/162, 82.7%), followed by MGIT 960 (99/135, 73.3%) and Myco/F (26/143, 18.1%), and the composite positive rate for GeneXpert and MGIT 960 was 96.6% (173/179). Pairwise comparisons were conducted after completion of both tests, and the results showed that Myco/F had significantly lower detection rates than GeneXpert and MGIT 960 (16.4% versus 82.8%, P < 0.001; 14.3% versus 71.4%, P < 0.001). In summary, GeneXpert was the most sensitive and recommended method for MTB detection in biopsy tissues, and the combination of GeneXpert and MGIT 960 could improve the overall diagnostic yield. IMPORTANCE Mycobacterium tuberculosis (MTB) poses a severe threat to public health worldwide. The diagnosis of tuberculosis is challenging due to the low load of the microorganism in samples. Biopsy tissues are sometimes collected via invasive procedures with limited size, and additional samples are often inaccessible. The GeneXpert MTB/RIF assay, Bactec MGIT 960 system, and Bactec Myco/F lytic system have been used in detecting MTB in our laboratory. Here, we evaluated the performances of these three methods in 3,209 biopsy tissues samples to establish a more effective protocol based on clinical requirements. Attempts for a locally optimized protocol should be always made.
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Affiliation(s)
- Jiankang Zhao
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Danni Pu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yulin Zhang
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuxin Qu
- Department of Clinical Laboratory, Shenzhen Third People’s Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), National Clinical Research Center for Infectious Diseases, Shenzhen, Guangdong, China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Cao
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
- Department of Respiratory Medicine, Capital Medical University, Beijing, China
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Nadig TR, Thomas N, Nietert PJ, Lozier J, Tanner NT, Wang Memoli JS, Pastis NJ, Silvestri GA. Guided Bronchoscopy for the Evaluation of Pulmonary Lesions: An Updated Meta-analysis. Chest 2023; 163:1589-1598. [PMID: 36640994 PMCID: PMC10925546 DOI: 10.1016/j.chest.2022.12.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Guided bronchoscopy is increasingly used to diagnose peripheral pulmonary lesions (PPLs). A meta-analysis published in 2012 demonstrated a pooled diagnostic yield of 70%; however, recent publications have documented yields as low as 40% and as high as 90%. RESEARCH QUESTION Has the diagnostic yield of guided bronchoscopy in patients with PPLs improved over the past decade? STUDY DESIGN AND METHODS A comprehensive search was performed of studies evaluating the diagnostic yield of differing bronchoscopic technologies used to reach PPLs. Study quality was assessed using the Quality assessment of diagnostic accuracy of studies (QUADAS-2) assessment tool. Number of lesions, type of technology used, overall diagnostic yield, and yield by size were extracted. Adverse events were recorded. Meta-analytic techniques were used to summarize findings across all studies. RESULTS A total of 16,389 lesions from 126 studies were included. There was no significant difference in diagnostic yield prior to 2012 (39 studies; 3,052 lesions; yield 70.5%) vs after 2012 (87 studies; 13,535 lesions; yield 69.2%) (P > .05). Additionally, there was no significant difference in yield when comparing different technologies. Studies with low risk of overall bias had a lower diagnostic yield than those with high risk of bias (66% vs 71%, respectively; P = .018). Lesion size > 2 cm, presence of bronchus sign, and reports with a high prevalence of malignancy in the study population were associated with significantly higher diagnostic yield. Significant (P < .0001) between-study heterogeneity was also noted. INTERPRETATION Despite the reported advances in bronchoscopic technology to diagnose PPLs, the diagnostic yield of guided bronchoscopy has not improved.
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Affiliation(s)
- Tejaswi R Nadig
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC
| | - Nina Thomas
- Division of Pulmonary Disease & Critical Care, University of Colorado, Aurora, CO
| | - Paul J Nietert
- Department of Public Health Sciences, MUSC, Charleston, SC
| | - Jessica Lozier
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC
| | - Nichole T Tanner
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC
| | - Jessica S Wang Memoli
- Division of Pulmonary, Critical Care and Respiratory Services, Medstar Washington Hospital Center, Washington, DC
| | - Nicholas J Pastis
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC.
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Wang J, Zhang T, Xu Y, Yang M, Huang Z, Lin J, Xie S, Sun H. Comparison between percutaneous transthoracic co-axial needle CT-guided biopsy and transbronchial lung biopsy for the diagnosis of persistent pulmonary consolidation. Insights Imaging 2023; 14:80. [PMID: 37166531 PMCID: PMC10175526 DOI: 10.1186/s13244-023-01436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Diagnosing persistent pulmonary consolidation still faces challenges. The purpose of this study is to compare the diagnostic yield and the complication rate between percutaneous transthoracic CT-guided coaxial needle biopsy (PTCNB) and transbronchial lung biopsy (TBLB) of persistent pulmonary consolidation. MATERIALS From January 1, 2016, to December 31, 2020, we have retrospectively enrolled a total of 155 consecutive patients (95 males, 60 females) with persistent pulmonary consolidation who underwent both TBLB and PTCNB. According to the standard reference, the diagnostic yield, accuracy, sensitivity and specificity of PTCNB and TBLB were assessed and compared. RESULTS According to the standard reference, the final biopsy diagnoses of 11 cases were confirmed true malignant based on the surgical resections, the remaining were confirmed by clinical and imaging follow-up for at least 12 months. The overall diagnostic accuracy, sensitivity and specificity of PTCNB for malignant diagnosis were 91.61%, 72.34% and 100%, whereas of TBLB were 87.74%, 59.57% and 100%. The diagnostic yield of PTCNB and TBLB were 50.32% and 25.16%, respectively. For the TBLB-based negative cases, PTCNB provided a definite diagnostic yield of 37.93%. There were 45 (29.03%), 22 (14.19%) and 13 (8.39%) patients who experienced pneumothorax, intrapulmonary hemorrhage and hemoptysis, respectively, in PTCNB, while there were only 5 (3.22%) cases of mild intraprocedural bleeding occurring in TBLB. CONCLUSIONS CT-guided co-axial needle biopsy is an effective and safe modality, associated with higher diagnostic yield and better diagnostic accuracy compared to transbronchial lung biopsy for malignancy presenting as persistent consolidation, especially as the complementary method for TBLB-based negative lung lesions. KEY POINTS Both PTCNB and TBLB showed high diagnostic accuracy for malignancy. PTCNB had a higher diagnostic yield than TBLB for persistent pulmonary consolidation. PTCNB could provide a complementary diagnosis for TBLB-based negative lung consolidation.
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Affiliation(s)
- Juan Wang
- Department of Radiology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Tongyin Zhang
- Department of Radiology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
- Graduate School, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Meng Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Huang
- Department of Radiology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Jie Lin
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
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Wook Kim Y, Kim HJ, Hyun Yoon S, Jin Song M, Soo Kwon B, Yoon Lim S, Joo Lee Y, Sun Park J, Cho YJ, Ho Lee J, Lee CT. Comparison of electromagnetic navigation bronchoscopy and transthoracic needle biopsy for diagnosing bronchus sign-positive pulmonary lesions. Lung Cancer 2023; 181:107234. [PMID: 37210790 DOI: 10.1016/j.lungcan.2023.107234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/15/2023] [Accepted: 05/06/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Electromagnetic navigation bronchoscopy (ENB) is an advanced technique for diagnosing peripheral pulmonary lesions, and the bronchus sign is a well-established factor for improving the diagnostic performance. However, ENB is a novel technology compared to the commonly adopted transthoracic needle biopsy (TTNB). There are limited data on the comparison of these techniques for diagnosing bronchus sign-positive lesions. Therefore, we aimed to compare the diagnostic yield and complication rates of ENB and TTNB for diagnosing lung cancer in bronchus sign-positive pulmonary lesions. MATERIALS AND METHODS We assessed 2,258 individuals who underwent either of the techniques for initial biopsy between September 2016 and May 2022 at a tertiary center in South Korea and analyzed 1,248 participants (153 ENB and 1,095 TTNB cases) with a positive bronchus sign. We performed multivariable logistic regression analyses to evaluate the factors associated with the diagnostic yield, sensitivity for malignancy, and procedure-related complications. In addition, the outcomes were compared between the two techniques after a 1:2 propensity score-matching to control for pre-procedural factors. RESULTS After adjustments for clinical/radiological factors, performing TTNB over ENB was not significantly associated with a higher diagnostic yield but with a higher risk of pneumothorax (OR = 9.69, 95% CI = 4.15-22.59). Propensity score-matching resulted in 459 participants (153 ENB and 306 TTNB cases) with balanced pre-procedural characteristics. The overall diagnostic yield did not differ significantly between ENB and TTNB (85.0% vs. 89.9%, p = 0.124). The diagnostic yield (86.7% vs. 90.3%, p = 0.280) and sensitivity for malignancy (85.3% vs. 88.8%, p = 0.361) were comparable among patients with a class 2 bronchus sign. However, TTNB demonstrated a significantly higher complication rate of pneumothorax (28.8% vs. 3.9%, p < 0.001) and pneumothorax requiring tube drainage (6.5% vs. 2.0%, p = 0.034) than ENB. CONCLUSION ENB demonstrated a diagnostic yield comparable with that of TTNB for diagnosing bronchus sign-positive peripheral pulmonary lesions with significantly lower complication rates.
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Affiliation(s)
- Yeon Wook Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Hyun Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byoung Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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9
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Kops SEP, Heus P, Korevaar DA, Damen JAA, Idema DL, Verhoeven RLJ, Annema JT, Hooft L, van der Heijden EHFM. Diagnostic yield and safety of navigation bronchoscopy: A systematic review and meta-analysis. Lung Cancer 2023; 180:107196. [PMID: 37130440 DOI: 10.1016/j.lungcan.2023.107196] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Navigation bronchoscopy has seen rapid development in the past decade in terms of new navigation techniques and multi-modality approaches utilizing different techniques and tools. This systematic review analyses the diagnostic yield and safety of navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules suspected of lung cancer. METHODS An extensive search was performed in Embase, Medline and Cochrane CENTRAL in May 2022. Eligible studies used cone-beam CT-guided navigation (CBCT), electromagnetic navigation (EMN), robotic navigation (RB) or virtual bronchoscopy (VB) as the primary navigation technique. Primary outcomes were diagnostic yield and adverse events. Quality of studies was assessed using QUADAS-2. Random effects meta-analysis was performed, with subgroup analyses for different navigation techniques, newer versus older techniques, nodule size, publication year, and strictness of diagnostic yield definition. Explorative analyses of subgroups reported by studies was performed for nodule size and bronchus sign. RESULTS A total of 95 studies (n = 10,381 patients; n = 10,682 nodules) were included. The majority (n = 63; 66.3%) had high risk of bias or applicability concerns in at least one QUADAS-2 domain. Summary diagnostic yield was 70.9% (95%-CI 68.4%-73.2%). Overall pneumothorax rate was 2.5%. Newer navigation techniques using advanced imaging and/or robotics(CBCT, RB, tomosynthesis guided EMN; n = 24 studies) had a statistically significant higher diagnostic yield compared to longer established techniques (EMN, VB; n = 82 studies): 77.5% (95%-CI 74.7%-80.1%) vs 68.8% (95%-CI 65.9%-71.6%) (p < 0.001).Explorative subgroup analyses showed that larger nodule size and bronchus sign presence were associated with a statistically significant higher diagnostic yield. Other subgroup analyses showed no significant differences. CONCLUSION Navigation bronchoscopy is a safe procedure, with the potential for high diagnostic yield, in particular using newer techniques such as RB, CBCT and tomosynthesis-guided EMN. Studies showed a large amount of heterogeneity, making comparisons difficult. Standardized definitions for outcomes with relevant clinical context will improve future comparability.
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Affiliation(s)
- Stephan E P Kops
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Pauline Heus
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Johanna A A Damen
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Demy L Idema
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel L J Verhoeven
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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10
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Zhang S, Guo F, Wang H, Chen M, Huang G, Zhu Y, Zheng W, Zheng B, Chen C. Comparative analysis of electromagnetic navigation bronchoscopy versus computed tomography-guided lung puncture for the sampling of indeterminate pulmonary nodules in the middle of an anatomic lung segment: A cohort study. Thorac Cancer 2022; 14:149-155. [PMID: 36464771 PMCID: PMC9834696 DOI: 10.1111/1759-7714.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND To compare the diagnostic positive rate and complication rate between the electromagnetic navigation bronchoscopy (ENB) technique and computed tomography (CT)-guided lung puncture for the biopsy of lung nodules located in the middle of an anatomic lung segment. METHODS Electronic medical records of 114 patients who underwent lung nodule biopsy between June 2021 and June 2022 were retrospectively evaluated. In all patients, the nodules were located in the middle third lung segment. To compare the diagnostic positive and complication rates between the two biopsy modalities performed in this lung region, clinical data, complication rates, nodule pathology, and imaging results were reviewed based on nodule characteristics retrieved from the electronic medical records. RESULTS Ninety-three patients underwent CT-guided lung puncture, while the remaining 21 patients underwent the ENB technique. No significant difference was observed in the diagnostic positive rate between the two groups (73.6 and 76.1%, respectively). In the CT-guided lung puncture group, pneumothorax incidence, tube placement, postoperative hemorrhage, and symptomatic hemorrhage rates were 16.1, 6.5, 6.5, and 1.1%, respectively. In contrast, no complications occurred in the ENB group. CONCLUSIONS The ENB technique is a safe and effective method for performing biopsies of pulmonary nodules with a diagnostic positive rate comparable to that of CT-guided lung puncture and with a lower postoperative complication rate.
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Affiliation(s)
- Shuliang Zhang
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Feilong Guo
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Hongjin Wang
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Maohui Chen
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Guanglei Huang
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Yong Zhu
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Wei Zheng
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Bin Zheng
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Chun Chen
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
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11
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Park HY, Suh CH, Kim SO. Use of "Diagnostic Yield" in Imaging Research Reports: Results from Articles Published in Two General Radiology Journals. Korean J Radiol 2022; 23:1290-1300. [PMID: 36447417 PMCID: PMC9747267 DOI: 10.3348/kjr.2022.0741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE "Diagnostic yield," also referred to as the detection rate, is a parameter positioned between diagnostic accuracy and diagnosis-related patient outcomes in research studies that assess diagnostic tests. Unfamiliarity with the term may lead to incorrect usage and delivery of information. Herein, we evaluate the level of proper use of the term "diagnostic yield" and its related parameters in articles published in Radiology and Korean Journal of Radiology (KJR). MATERIALS AND METHODS Potentially relevant articles published since 2012 in these journals were identified using MEDLINE and PubMed Central databases. The initial search yielded 239 articles. We evaluated whether the correct definition and study setting of "diagnostic yield" or "detection rate" were used and whether the articles also reported companion parameters for false-positive results. We calculated the proportion of articles that correctly used these parameters and evaluated whether the proportion increased with time (2012-2016 vs. 2017-2022). RESULTS Among 39 eligible articles (19 from Radiology and 20 from KJR), 17 (43.6%; 11 from Radiology and 6 from KJR) correctly defined "diagnostic yield" or "detection rate." The remaining 22 articles used "diagnostic yield" or "detection rate" with incorrect meanings such as "diagnostic performance" or "sensitivity." The proportion of correctly used diagnostic terms was higher in the studies published in Radiology than in those published in KJR (57.9% vs. 30.0%). The proportion improved with time in Radiology (33.3% vs. 80.0%), whereas no improvement was observed in KJR over time (33.3% vs. 27.3%). The proportion of studies reporting companion parameters was similar between journals (72.7% vs. 66.7%), and no considerable improvement was observed over time. CONCLUSION Overall, a minority of articles accurately used "diagnostic yield" or "detection rate." Incorrect usage of the terms was more frequent without improvement over time in KJR than in Radiology. Therefore, improvements are required in the use and reporting of these parameters.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Efficacy and Safety Analysis of Multislice Spiral CT-Guided Transthoracic Lung Biopsy in the Diagnosis of Pulmonary Nodules of Different Sizes. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8192832. [PMID: 36060660 PMCID: PMC9436531 DOI: 10.1155/2022/8192832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
Objective This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes. Methods Data of 78 patients with pulmonary nodules who underwent CT-guided transthoracic lung biopsy in our hospital from January 2020 to December 2021 were retrospectively analyzed, and they were divided into the small nodules group (n = 12), medium nodules group (n = 35), and large nodules group (n = 31) according to the diameter of pulmonary nodules. The results of puncture biopsy and final diagnosis of pulmonary nodules of different sizes were compared. The incidence of complications in patients with pulmonary nodules of different sizes was compared. Univariate analysis was used to compare the incidence of complications in 78 patients. Logistic multiple regression analysis was used to analyze the independent risk factors of pneumothorax in patients with pulmonary nodule puncture. Logistic multiple regression analysis was used to analyze the independent risk factors of pulmonary hemorrhage in patients with pulmonary nodule puncture. Results The diagnostic accuracy, sensitivity, and specificity were 83.33%, 100.00%, and 77.78% in small nodules group. The diagnostic accuracy, sensitivity, and specificity of medium nodules group were 85.71%, 100.00%, and 73.68%, respectively. The diagnostic accuracy, sensitivity, and specificity of large nodules group were 93.55%, 100.00%, and 33.33%, respectively. There was no significant difference in the incidence of pneumothorax among the three groups (P > 0.05). The incidence of pulmonary hemorrhage in small nodule group was higher than that in the medium nodule group and large nodule group, and the difference was statistically significant (P < 0.05). There was no significant difference in the incidence of total complications among the three groups (P > 0.05). There were statistically significant differences in clinical data such as the needle tract length, the puncture position, and the distance of the puncture needle passing through the lung tissue in patients with or without pneumothorax (P < 0.05). There were statistically significant differences in needle tract length, distance of puncture needle passing through lung tissue, and size of pulmonary nodules in patients with or without pulmonary hemorrhage (P > 0.05). Logistic multivariate analysis showed that needle tract length ≤ 50 mm, lateral decubitus position, and the distance of puncture needle passing through lung tissue ≥ 14 mm were independent risk factors for pneumothorax after puncture in patients with pulmonary nodules (P < 0.05). The needle tract length > 50 mm, the distance of puncture needle passing through lung tissue ≥ 14 mm, and small nodules (pulmonary nodules diameter ≤ 10 mm) were independent risk factors for pulmonary hemorrhage after puncture in patients with pulmonary nodules (P < 0.05). Conclusion Multislice spiral CT-guided transthoracic lung biopsy is effective in diagnosing pulmonary nodules of different sizes.
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13
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Palumbo R, Sarwar Z, Stewart KE, Garwe T, Reinersman JM. Predictors of Success When Implementing an Electromagnetic Navigational Bronchoscopy Program. J Surg Res 2022; 274:248-253. [PMID: 35216801 DOI: 10.1016/j.jss.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/10/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION With the advent of lung cancer screening, lung nodules are being discovered at an increasing rate. With improvements in transbronchial biopsy technology, it is important for thoracic surgeons to be involved with diagnostic procedures. The aim of this project is to relate the thoracic surgeon experience in implementing an electromagnetic navigational bronchoscopy (ENB) program at our institution and describe the factors that led to successful navigation (the ability to position a biopsy instrument in range for biopsy) and diagnostic biopsy of nodules. METHODS The thoracic surgery ENB program was initiated in 2014. A retrospective analysis of patients referred to thoracic surgery from 2014 to 2019 for lung nodule evaluation was performed. Patients who underwent ENB and biopsy were included. Recursive partitioning (CART) and multivariable regression analyses were used to identify predictors of successful navigation and biopsy. RESULTS There were 73 patients who underwent ENB evaluation of 91 nodules from 2014 to 2019. There was successful navigation in 75.8% of nodules, and on multivariable analysis, bronchus sign, lesion size, and pleural distance were significant predictors of successful navigation. Of the lesions that had successful navigation, 65.2% had a diagnostic biopsy. Based on CART analysis, positive bronchus sign and lesion size ≥ 1.3 cm were most predictive of obtaining a diagnostic biopsy with a probability of 0.75. CONCLUSIONS Nodule size, distance to the pleura, and bronchus size are independent variables of successful navigation when using ENB. However, of the lesions that were successfully reached, combined lesion size >1.3 cm and a positive bronchus sign were most predictive of obtaining a diagnostic biopsy. These factors should be considered when implementing an ENB program in a thoracic surgery practice.
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Affiliation(s)
- Rachael Palumbo
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Zoona Sarwar
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kenneth E Stewart
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Tabitha Garwe
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - J Matthew Reinersman
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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14
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Shape-Sensing Robotic-Assisted Bronchoscopy in the Diagnosis of Pulmonary Parenchymal Lesions. Chest 2022; 161:572-582. [PMID: 34384789 PMCID: PMC8941601 DOI: 10.1016/j.chest.2021.07.2169] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The landscape of guided bronchoscopy for the sampling of pulmonary parenchymal lesions is evolving rapidly. Shape-sensing robotic-assisted bronchoscopy (ssRAB) recently was introduced as means to allow successful sampling of traditionally challenging lesions. RESEARCH QUESTION What are the feasibility, diagnostic yield, determinants of diagnostic sampling, and safety of ssRAB in patients with pulmonary lesions? STUDY DESIGN AND METHODS Data from 131 consecutive ssRAB procedures performed at a US-based cancer center between October 2019 and July 2020 were captured prospectively and analyzed retrospectively. Definitions of diagnostic procedures were based on prior standards. Associations of procedure- and lesion-related factors with diagnostic yield were examined by univariate and multivariate generalized linear mixed models. RESULTS A total of 159 pulmonary lesions were targeted during 131 ssRAB procedures. The median lesion size was 1.8 cm, 59.1% of lesions were in the upper lobe, and 66.7% of lesions were beyond a sixth-generation airway. The navigational success rate was 98.7%. The overall diagnostic yield was 81.7%. Lesion size of ≥ 1.8 cm and central location were associated significantly with a diagnostic procedure in the univariate analysis. In the multivariate model, lesions of ≥ 1.8 cm were more likely to be diagnostic compared with lesions < 1.8 cm, after adjusting for lung centrality (OR, 12.22; 95% CI, 1.66-90.10). The sensitivity and negative predictive value of ssRAB for primary thoracic malignancies were 79.8% and 72.4%, respectively. The overall complication rate was 3.0%, and the pneumothorax rate was 1.5%. INTERPRETATION This study was the first to provide comprehensive evidence regarding the usefulness and diagnostic yield of ssRAB in the sampling of pulmonary parenchymal lesions. ssRAB may represent a significant advancement in the ability to access and sample successfully traditionally challenging pulmonary lesions via the bronchoscopic approach, while maintaining a superb safety profile. Lesion size seems to remain the major predictor of a diagnostic procedure.
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15
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Folch EE, Bowling MR, Pritchett MA, Murgu SD, Nead MA, Flandes J, Krimsky WS, Mahajan AK, LeMense GP, Murillo BA, Bansal S, Lau K, Gildea TR, Christensen M, Arenberg DA, Singh J, Bhadra K, Hogarth DK, Towe CW, Lamprecht B, Bezzi M, Mattingley JS, Hood KL, Lin H, Wolvers JJ, Khandhar SJ. NAVIGATE 24-Month Results: Electromagnetic navigation bronchoscopy for pulmonary lesions at 37 centers in Europe and the United States. J Thorac Oncol 2021; 17:519-531. [PMID: 34973418 DOI: 10.1016/j.jtho.2021.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive, image-guided approach to access lung lesions for biopsy or localization for treatment. However, no studies have reported prospective 24-month follow-up from a large, multinational, generalizable cohort. This study evaluated ENB safety, diagnostic yield, and usage patterns in an unrestricted, real-world observational design. METHODS The NAVIGATE single-arm, pragmatic cohort study (NCT02410837) enrolled subjects at 37 academic and community sites in 7 countries with prospective 24-month follow-up. Subjects underwent ENB using the superDimension navigation system versions 6.3 to 7.1. The prespecified primary endpoint was procedure-related pneumothorax requiring intervention or hospitalization. RESULTS A total of 1,388 subjects were enrolled for lung lesion biopsy (1,329; 95.7%), fiducial marker placement (272; 19.6%), dye marking (23; 1.7%), and/or lymph node biopsy (36; 2.6%). Concurrent endobronchial ultrasound-guided staging occurred in 456 subjects. General anesthesia (78.2% overall, 56.6% Europe, 81.4% US), radial endobronchial ultrasound (50.6%, 4.0%, 57.4%), fluoroscopy (85.0%, 41.7%, 91.0%), and rapid on-site evaluation use (61.7%, 17.3%, 68.5%) differed between regions. Pneumothorax and bronchopulmonary hemorrhage occurred in 4.7% and 2.7% of subjects, respectively (3.2% [primary endpoint] and 1.7% requiring intervention or hospitalization). Respiratory failure occurred in 0.6%. The diagnostic yield was 67.8% (range 61.9%-70.7%; 55.2% Europe, 69.8% US). Sensitivity for malignancy was 62.6%. Lung cancer clinical stage was I-II in 64.7% (55.3% Europe, 65.8% US). CONCLUSIONS Despite a heterogeneous cohort and regional differences in procedural techniques, ENB demonstrates low complications and a 67.8% diagnostic yield while allowing biopsy, staging, fiducial placement, and dye marking in a single procedure.
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Affiliation(s)
- Erik E Folch
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 148, Boston, MA 02114
| | - Mark R Bowling
- Brody School of Medicine, East Carolina University, 500 Moye Blvd, Greenville, NC 27834
| | - Michael A Pritchett
- FirstHealth of the Carolinas and Pinehurst Medical Clinic, 205 Page Road, Pinehurst, NC, 28374
| | - Septimiu D Murgu
- University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - Michael A Nead
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester NY 14642
| | - Javier Flandes
- Hospital Fundación Jiménez Díaz IIS-FJD Ciberes, Avda. Reyes Católicos 2, Madrid 28043, Spain
| | - William S Krimsky
- Pulmonary and Critical Care Associates of Baltimore, 9103 Franklin Square Drive, Suite 300, Baltimore, MD 21237
| | - Amit K Mahajan
- Inova Health System, Virginia Cancer Specialists, 2921 Telestar Court, Falls Church, VA, 22042
| | - Gregory P LeMense
- Blount Memorial Physicians Group(†), 266 Joule Street, Alcoa, TN 37701
| | - Boris A Murillo
- Providence Health Center and Waco Lung Associates, 340 Richland West Circle, Waco, TX 76657
| | - Sandeep Bansal
- Penn Highlands Healthcare, 100 Hospital Avenue, PO Box 447, DuBois, PA 15801
| | - Kelvin Lau
- St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Thomas R Gildea
- Cleveland Clinic, 9500 Euclid Avenue MC M2-141, Cleveland, OH 44195
| | - Merete Christensen
- Rigshospitalet, Thoraxkirurgisk klin 78ik RT 2151, Copenhagen, Denmark, Merete.Christensen
| | - Douglas A Arenberg
- University of Michigan, 1150 West Medical Center Drive, University of Michigan, Ann Arbor, MI, 48109
| | - Jaspal Singh
- Atrium Health and Levine Cancer Institute, 503B Med Ed Building, Charlotte, NC, 28203
| | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, 725 Glenwood Dr E-500, Chattanooga, TN, 37401
| | - D Kyle Hogarth
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - Christopher W Towe
- University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106
| | - Bernd Lamprecht
- Kepler Universitätsklinikum, 4021 Linz, Krankenhausstraße 9, Linz, Austria
| | - Michela Bezzi
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, 3 - 50134, Florence, Italy
| | | | - Kristin L Hood
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Haiying Lin
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Jennifer J Wolvers
- Medtronic, Clinical Research and Medical Science, 161 Cheshire Ln, Plymouth, MN 55441
| | - Sandeep J Khandhar
- Inova Health System, Virginia Cancer Specialists, 8503 Arlington Blvd, Fairfax, VA, 22031
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Bao F, Yu F, Wang R, Chen C, Zhang Y, Lin B, Wang Y, Hao X, Gu Z, Fang W. Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule. Transl Lung Cancer Res 2021; 10:3759-3770. [PMID: 34733626 PMCID: PMC8512468 DOI: 10.21037/tlcr-21-474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with early-stage lung cancer are sometimes medically inoperable, and for patients with multiple primary lung cancers, surgical resection alone sometimes proves to be impractical. Local treatments like microwave ablation (MWA) are investigational alternatives for these patients. Most reported MWA procedures for lung cancers are performed percutaneously under CT guidance. MWA navigated by electromagnetic bronchoscopy (ENB) has been limitedly studied. In this study, we aimed to evaluate the safety and feasibility of MWA under ENB guidance in patients with inoperable early-stage lung cancers or multiple primary lung cancers which cannot be completely resected. Methods From June 2019 to December 2020, preliminary attempts of ENB-guided MWA were made in five medically inoperable patients with a single early-stage lung cancer and ten patients with multiple primary lung cancers which were difficult to resect at the same time. For patients with concomitant pulmonary nodules which needed surgical resection, thoracoscopic resections were performed following ENB-guided MWA. The safety, feasibility, and technique effectiveness of treatments were evaluated. Results ENB-guided MWA for 15 ground glass nodules (GGNs) in 15 patients was completed in accordance with the planned protocol. Biopsy of 13 GGNs showed malignancy. Five patients received simple ENB-guided MWA without simultaneous surgical resection and ten patients received simultaneous surgical resection for 13 concomitant pulmonary nodules. CT scan by the first postoperative week showed technique effectiveness of ablation for 11 nodules indicated for MWA. Four patients had mild complications after the procedure and recovered shortly after treatment. Conclusions For medically inoperable patients with a single GGN manifesting early-stage lung cancer and patients with multiple primary early-stage lung cancers which cannot be resected at the same time, ENB-guided MWA might be a safe and feasible alternative local treatment, whether combined with surgical resection or not. However, large, prospective, randomized, multicenter studies are needed to confirm its role in the treatment of early-stage lung cancer.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fenghao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghui Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Boyu Lin
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Shen YC, Chen CH, Tu CY. Advances in Diagnostic Bronchoscopy. Diagnostics (Basel) 2021; 11:diagnostics11111984. [PMID: 34829331 PMCID: PMC8620115 DOI: 10.3390/diagnostics11111984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022] Open
Abstract
The increase in incidental discovery of pulmonary nodules has led to more urgent requirement of tissue diagnosis. The peripheral pulmonary nodules are especially challenging for clinicians. There are various modalities for diagnosis and tissue sampling of pulmonary lesions, but most of these modalities have their own limitations. This has led to the development of many advanced technical modalities, which have empowered pulmonologists to reach the periphery of the lung safely and effectively. These techniques include thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (RP-EBUS), and navigation bronchoscopy—including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB). Recently, newer technologies—including robotic-assisted bronchoscopy (RAB), cone-beam CT (CBCT), and augmented fluoroscopy (AF)—have been introduced to aid in the navigation to peripheral pulmonary nodules. Technological advances will also enable more precise tissue sampling of smaller peripheral lung nodules for local ablative and other therapies of peripheral lung cancers in the future. However, we still need to overcome the CT-to-body divergence, among other limitations. In this review, our aim is to summarize the recent advances in diagnostic bronchoscopy technology.
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Affiliation(s)
- Yi-Cheng Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40447, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40447, Taiwan
- School of Medicine, China Medical University, Taichung 40447, Taiwan
- Correspondence: (C.-H.C.); (C.-Y.T.); Tel.: +886-4-22052121 (ext. 2623) (C.-H.C.); +886-4-22052121 (ext. 3485) (C.-Y.T.); Fax: +886-4-22038883 (C.-H.C. & C.-Y.T.)
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40447, Taiwan
- School of Medicine, China Medical University, Taichung 40447, Taiwan
- Correspondence: (C.-H.C.); (C.-Y.T.); Tel.: +886-4-22052121 (ext. 2623) (C.-H.C.); +886-4-22052121 (ext. 3485) (C.-Y.T.); Fax: +886-4-22038883 (C.-H.C. & C.-Y.T.)
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Deshwal H, Mehta AC, Munavvar M. Gone with the wind! Changes in the practice of bronchoscopy post pandemic: A perspective. Ann Thorac Med 2021; 16:221-224. [PMID: 34484436 PMCID: PMC8388567 DOI: 10.4103/atm.atm_552_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/05/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Himanshu Deshwal
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Shi J, He J, He J, Li S. Electromagnetic navigation-guided preoperative localization: the learning curve analysis. J Thorac Dis 2021; 13:4339-4348. [PMID: 34422360 PMCID: PMC8339733 DOI: 10.21037/jtd-21-490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/19/2021] [Indexed: 12/11/2022]
Abstract
Background The electromagnetic navigation bronchoscopy (ENB) was increasingly used to mark small pulmonary nodules (PNs) for video-assisted thoracic surgery (VATS) resection due to high effectiveness and low risk. However, no study reports the learning curve of ENB-guided preoperative localization. In the study, we aimed to describe the learning curve of ENB-guided preoperative PNs localization initially. Methods Consecutive PNs cases that underwent ENB localizations between October 2018 and October 2019 by the same surgeon in our center were included in the study. The cumulative sum (CUSUM) method was used to analyze the learning curve of ENB localization. Results A total of 89 ENB localization from 64 patients were included in this study. The learning curve was divided into 3 phases: Phase I (the initial 11 cases), Phase II (the 12th to the 47th cases), and Phase III (the 47th to the 89th cases). The success rate of ENB localization has increased with the accumulation of operational experience in 3 phases (72.73%, 91.67%, and 97.62%, P=0.049). The distance from the ENB guide wire tip to the center of the lesion in Phase I was significantly longer than those in Phase II and Phase III (2.46±1.76 vs. 1.36±0.94 and 1.47±0.97 cm, P=0.014 and 0.027, respectively). Sex, bronchus sign, and learning curve phase were independent risk factors influencing operative time (OT) (OR =8.187, 18.847, and 13.920, respectively). Conclusions The technical competency, which is indicated by higher success rate, localization accuracy, and shorter OT, for ENB-guided preoperative PNs localization was achieved at the 47th operation.
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Affiliation(s)
- Jiang Shi
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory and National Clinical Research Center for Respiratory Disease, Guangzhou, China
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20
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Zlevor AM, Mauch SC, Knott EA, Pickhardt PJ, Mankowski Gettle L, Mao L, Meyer CA, Hartung MP, Kim DH, Lubner MG, Hinshaw JL, Foltz ML, Ziemlewicz TJ, Lee FT. Percutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching: Results and Complications from 1,112 Core Biopsies. J Vasc Interv Radiol 2021; 32:1319-1327. [PMID: 34229043 DOI: 10.1016/j.jvir.2021.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the outcomes of computed tomography (CT) fluoroscopy-guided core lung biopsies with emphasis on diagnostic yield, complications, and efficacy of parenchymal and pleural blood patching to avoid chest tube placement. METHODS This is a single-center retrospective analysis of CT fluoroscopy-guided percutaneous core lung biopsies between 2006 and 2020. Parenchymal blood patching during introducer needle withdrawal was performed in 74% of cases as a preventive measure, and pleural blood patching was the primary salvage maneuver for symptomatic or growing pneumothorax in 60 of 83 (72.2%) applicable cases. RESULTS A total of 1,029 patients underwent 1,112 biopsies (532 men; mean age, 66 years; 38.6%, history of emphysema; lesion size, 16.7 mm). The diagnostic yield was 93.6% (1,032/1,103). Fewer complications requiring intervention were observed in patients who underwent parenchymal blood patching (5.7% vs 14.2%, P < .001). Further intervention was required in 83 of 182 pneumothorax cases, which included the following: (a) pleural blood patch (5.4%, 60/1,112), (b) chest tube placement without a pleural blood patch attempt (1.5%, 17/1,112), and (c) simple aspiration (0.5%, 6/1,112). Pleural blood patch as monotherapy was successful in 83.3% (50/60) of cases without need for further intervention. The overall chest tube rate was 2.6% (29/1,112). Emphysema was the only significant risk factor for complications requiring intervention (P ≤ .001). CONCLUSIONS Parenchymal blood patching during introducer needle withdrawal decreased complications requiring intervention. Salvage pleural blood patching reduced the frequency of chest tube placement for pneumothorax.
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Affiliation(s)
- Annie M Zlevor
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Scott C Mauch
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Emily A Knott
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | | | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | | | - Michael P Hartung
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - David H Kim
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, Madison, Wisconsin; Department of Urology, University of Wisconsin, Madison, Wisconsin
| | - Marcia L Foltz
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, Wisconsin; Department of Urology, University of Wisconsin, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin.
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21
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Ngo DQ, Aftab G, Frenia D. The Utility of Point-of-Care Ultrasound for Post-Bronchoscopy Pneumothorax Evaluation. Cureus 2021; 13:e15339. [PMID: 34235018 PMCID: PMC8241540 DOI: 10.7759/cureus.15339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/19/2022] Open
Abstract
We present a case of a 65-year-old female with a prior history of B-cell lymphoma with new CT chest findings of a nodule requiring an electromagnetic navigational bronchoscopy with transbronchial biopsies. Post-bronchoscopy, the patient complained of dyspnea and left scapular pain despite two normal anterior-posterior chest X-rays. Point-of-care ultrasound of the lung demonstrated a lack of lung sliding, which was confirmed via a right lateral decubitus chest X-ray. This case illustrates the utility and superiority of lung point-of-care ultrasound while highlighting the limitations of conventional imaging modalities in a post-bronchoscopy evaluation.
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Affiliation(s)
- Dallis Q Ngo
- Pulmonary Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Ghulam Aftab
- Pulmonary Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Douglas Frenia
- Pulmonary Critical Care, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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22
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Shin YJ, Yun G, Yoon SH, Song H, Kim J, Kim J, Park JS, Lee KW, Lee KH. Accuracy and complications of percutaneous transthoracic needle lung biopsy for the diagnosis of malignancy in patients with idiopathic pulmonary fibrosis. Eur Radiol 2021; 31:9000-9011. [PMID: 34003347 DOI: 10.1007/s00330-021-08038-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine the accuracy of CT-guided percutaneous transthoracic needle lung biopsy (PTNB) for the diagnosis of malignancy and the associated complication rates in patients with idiopathic pulmonary fibrosis (IPF). METHODS This retrospective study included 91 CT-guided PTNBs performed in 80 patients with IPF from April 2003 through December 2016. Data regarding patients, target lesions, procedures, complications, and pathological reports were collected, and the final diagnosis was made. The diagnostic accuracy, sensitivity, specificity, percentage of nondiagnostic results, and complication rates were determined. Multivariable logistic regression analyses were performed to identify risk factors for nondiagnostic results and major complications. RESULTS Three biopsies (technical failure [n = 2] and undetermined final diagnosis [n = 1]) were excluded from the diagnostic accuracy calculation. The diagnostic accuracy, sensitivity, and specificity were 89% (78/88), 90% (62/69), and 84% (16/19), respectively. The percentage of nondiagnostic results was 34% (30/88). Lesion size ≤ 3 cm (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.5-31.2; p = 0.001) and needle tip placement outside the target lesion (OR, 13.7; 95% CI, 1.4-132.2; p = 0.02) were risk factors for nondiagnostic results. The overall and major complication rates were 51% (46/91) and 12% (11/91), respectively. The presence of honeycombing along the path of the needle (OR, 11.2; 95% CI, 1.4-89.1; p = 0.02) was an independent risk factor for major complications. CONCLUSIONS CT-guided PTNB shows a relatively reasonable accuracy in diagnosing malignancy in patients with IPF. The complication rate may be high, especially when the needle passes through honeycomb lesions. KEY POINTS • In patients with idiopathic pulmonary fibrosis (IPF), CT-guided percutaneous transthoracic needle lung biopsy (PTNB) showed a relatively reasonable accuracy for the diagnosis of malignancy. • Target lesion size ≤ 3 cm and biopsy needle tip placement outside the target lesion were risk factors for nondiagnostic results of CT-guided PTNB. • The complication rate may be high, especially in cases where the biopsy needle passes through honeycomb lesions.
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Affiliation(s)
- Yoon Joo Shin
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.,Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Gabin Yun
- Department of Radiology, Division of Cardiothoracic Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sung Hyun Yoon
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Hwayoung Song
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.,Department of Radiology , Seongnam Citizens Medical Center , Seongnam, Korea
| | - Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Deptartment of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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23
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Endobronchial Navigation Guided by Cone-Beam CT–Based Augmented Fluoroscopy without a Bronchoscope: Feasibility Study in Phantom and Swine. J Vasc Interv Radiol 2020; 31:2122-2131. [DOI: 10.1016/j.jvir.2020.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
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24
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Jiang J, Chang SH, Kent AJ, Geraci TC, Cerfolio RJ. Current Novel Advances in Bronchoscopy. Front Surg 2020; 7:596925. [PMID: 33304923 PMCID: PMC7701114 DOI: 10.3389/fsurg.2020.596925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022] Open
Abstract
Screening for lung cancer has changed substantially in the past decade since The National Lung Screening Trial. The resultant increased discovery of incidental pulmonary nodules has led to a growth in the number of lesions requiring tissue diagnosis. Bronchoscopy is one main modality used to sample lesions, but peripheral lesions remain challenging for bronchoscopic biopsy. Alternatives have included transthoracic biopsy or operative biopsy, which are more invasive and have a higher morbidity than bronchoscopy. In hopes of developing less invasive diagnostic techniques, technologies have come to assist the bronchoscopist in reaching the outer edges of the lung. Navigational bronchoscopy is able to virtually map the lung and direct the biopsy needle where the scope cannot reach. Robotic bronchoscopy platforms have been developed to provide stability and smaller optics to drive deeper into the bronchial tree. While these new systems have not yet proven better outcomes, they may reduce the need for invasive procedures and be valuable armamentarium in diagnosing and treating lung nodules, especially in the periphery.
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Affiliation(s)
- Jeffrey Jiang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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25
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Kent AJ, Byrnes KA, Chang SH. State of the Art: Robotic Bronchoscopy. Semin Thorac Cardiovasc Surg 2020; 32:1030-1035. [PMID: 32846232 DOI: 10.1053/j.semtcvs.2020.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/08/2020] [Accepted: 08/15/2020] [Indexed: 12/25/2022]
Abstract
Increased detection of lung nodules has led to trying to improve technologies for localization and/or tissue acquisition. Previous bronchoscopic techniques have limitations that have led to further advancements in technology. Robotic bronchoscopy has emerged as new technology for the localization, diagnosis, and potential treatment of lung nodules. The robotic bronchoscopic platform was developed to improve peripheral reach of lung nodules, provide direct continuous visualization of the periphery, and offer more precise control of the instrumentation. We review the progression of bronchoscopy, evolution to the robotic platform and its early outcomes, with considerations for future advancements.
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Affiliation(s)
- Amie J Kent
- Department of Cardiothoracic Surgery, New York University Langone Health, New York NY, USA.
| | - Kim A Byrnes
- Nova Southeastern University Dr. Kiran C. Patel School of Osteopathic Medicine
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York NY, USA
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26
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Zhou Z, Li C, Zhu R, Wang D, Liu T, Jia J, Wang F, Zhao L, Dong L, Yu X, Huang H. Combination of Percutaneous Lung Biopsy and Xpert MTB/RIF Ultra Enhances the Differential Diagnosis of Tuberculosis: A Prospective Cohort Study. Infect Dis Ther 2020; 9:797-806. [PMID: 32770473 PMCID: PMC7680488 DOI: 10.1007/s40121-020-00327-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction To evaluate the value of the combination of computed tomography (CT)-guided percutaneous lung biopsy and Xpert MTB/RIF Ultra (Xpert-Ultra) in enhancing the differential diagnosis of tuberculosis. Methods Patients with lesions in the lungs for whom the differential diagnosis was difficult were prospectively and consecutively enrolled. Specimens collected by percutaneous lung biopsy were subject to Xpert-Ultra and histopathologic examination, respectively. Results Biopsy was successfully performed for 147 patients who were eligible for analysis, including 65 TB, 55 lung cancer and 27 other chronic infection cases. The sensitivity, specificity, positive predictive value and negative predictive value of Xpert-Ultra for TB diagnosis were 75.38% (49/65) and 95.12% (78/82), 92.45% (49/53) and 82.98% (78/94), respectively. Among patients with strong evidence for TB diagnosis (categorized as confirmed or probable TB cases), the overall positive rate of the Xpert-Ultra assay was 83.63% (46/55), which was much higher than for any reported sample type with negative smear test outcomes to date. Five rifampicin (RIF)-resistant cases were identified using the biopsy tissues. However, “trace” positive did not seem reliable for TB diagnosis with lung biopsy specimens; a 25.61% (21/82) “trace”-positive rate was acquired in the non-TB group. Conclusion Percutaneous lung biopsy combined with Xpert-Ultra produced high sensitivity for culture-negative pulmonary TB patient diagnosis. “Trace” outcome might not be a reliable positive category for lung biopsy specimens. Trial registration ClinicalTrials.gov identifier, ChiCTR1900026412. Retrospectively registered on Oct 8th, 2019).
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Affiliation(s)
- Zhen Zhou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Chenghai Li
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Rui Zhu
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Dongpo Wang
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Tao Liu
- Department of Anesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Junnan Jia
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Fen Wang
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Liping Zhao
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Lingling Dong
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Xia Yu
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
| | - Hairong Huang
- National Tuberculosis Clinical Laboratory, Beijing Key Laboratory for Drug Resistance Tuberculosis Research. Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
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27
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Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies. Sci Rep 2020; 10:10978. [PMID: 32620852 PMCID: PMC7335035 DOI: 10.1038/s41598-020-67348-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist's level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p < 0.0001), overall pneumothorax (38%, p = 0.001) and had chest tube insertion (9%, p = 0.006) compared to those who did not when analysed with the Mann-Whitney U-test. In logistic regression analysis with inclusion of the other possible impact factors, the quantitative emphysema score remained a statistically significant predictor for all three output parameters. This was confirmed with least absolute shrinkage and selection operator (Lasso) regression analysis. In conclusion, quantitatively determined pulmonary emphysema is a positive predictor of the pneumothorax rate in CT-guided lung biopsy and likelihood of chest tube insertion.
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28
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Atkins NK, Marjara J, Kaifi JT, Kunin JR, Saboo SS, Davis RM, Bhat AP. Role of Computed Tomography-guided Biopsies in the Era of Electromagnetic Navigational Bronchoscopy: A Retrospective Study of Factors Predicting Diagnostic Yield in Electromagnetic Navigational Bronchoscopy and Computed Tomography Biopsies. J Clin Imaging Sci 2020; 10:33. [PMID: 32547836 PMCID: PMC7294316 DOI: 10.25259/jcis_53_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: Over 25% of the high-risk population screened for lung cancer have an abnormal computed tomography (CT) scan. Conventionally, these lesions have been biopsied with CT guidance with a high diagnostic yield. Electromagnetic navigational bronchoscopy (ENB) with transbronchial biopsy has emerged as a technology that improves the diagnostic sensitivity of conventional bronchoscopic biopsy. It has been used to biopsy lung lesions, due to the low risk of pneumothorax. It is, however, a new technology that is expensive and its role in the diagnosis of the solitary pulmonary nodule (SPN) is yet to be determined. The purpose of this study was to evaluate the diagnostic yield of CT-guided biopsy (CTB) following non-diagnostic ENB biopsy and identify characteristics of the lesion that predicts a low diagnostic yield with ENB, to ensure appropriate use of ENB in the evaluation of SPN. Materials and Methods: One hundred and thirty-five lung lesions were biopsied with ENB from January 2017 to August 2019. Biopsies were considered diagnostic if pathology confirmed malignancy or inflammation in the appropriate clinical and imaging setting. We evaluated lesions for several characteristics including size, lobe, and central/peripheral distribution. The diagnostic yield of CTB in patients who failed ENB biopsies was also evaluated. Logistic regression was used to identify factors likely to predict a non-diagnostic ENB biopsy. Result: Overall, ENB biopsies were performed in 135 patients with solitary lung lesions. ENB biopsies were diagnostic in 52% (70/135) of the patients. In 23 patients with solitary lung lesions, CTBs were performed following a non-diagnostic ENB biopsy. The CTBs were diagnostic in 87% of the patients (20/23). ENB biopsies of lesions <21.5 mm were non-diagnostic in 71% of cases (42/59); 14 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% of them were diagnostic (12/14). ENB biopsies of lesions in the lower lobes were non- diagnostic in 59% of cases (35/59); 12 of these patients with non-diagnostic ENB biopsies had CTBs, and 83% were diagnostic (10/12). ENB biopsies of lesions in the outer 2/3 were non-diagnostic in 57% of cases (50/87); 21 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% were diagnostic (18/21). Conclusion: CTBs have a high diagnostic yield even following non-diagnostic ENB biopsies. Lesions <21.5 mm, in the outer 2/3 of the lung, and in the lower lung have the lowest likelihood of a diagnostic yield with ENB biopsies. Although CTBs have a slightly higher pneumothorax rate, these lesions would be more successfully diagnosed with CTB as opposed to ENB biopsy, in the process expediting the diagnosis and saving valuable medical resources.
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Affiliation(s)
- Naomi K Atkins
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Jasraj Marjara
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Jussuf T Kaifi
- Departments of Cardiothoracic Surgery, University of Missouri, Columbia, Missouri, United States
| | - Jeffrey R Kunin
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Sachin S Saboo
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas, United States
| | - Ryan M Davis
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Ambarish P Bhat
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
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29
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Pritchett MA, Bhadra K, Calcutt M, Folch E. Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy. J Thorac Dis 2020; 12:1595-1611. [PMID: 32395297 PMCID: PMC7212155 DOI: 10.21037/jtd.2020.01.35] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Guided bronchoscopy offers a minimally invasive and safe method for accessing indeterminate pulmonary nodules. However, all current guided bronchoscopy systems rely on a preprocedural computed tomography (CT) scan to create a virtual map of the patient's airways. Changes in lung anatomy between the preprocedural CT scan and the bronchoscopy procedure can lead to a divergence between the expected and actual location of the target lesion. Termed "CT-to-body divergence", this effect reduces diagnostic yield, adds time to the procedure, and can be challenging for the operator. The objective of this paper is to describe the concept of CT-to-body divergence, its contributing factors, and methods and technologies that might minimize its deleterious effects on diagnostic yield.
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Affiliation(s)
- Michael A Pritchett
- FirstHealth of the Carolinas and Pinehurst Medical Clinic, Pinehurst, NC, USA
| | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN, USA
| | - Mike Calcutt
- Clinical Education, Medtronic, Minneapolis, MN, USA
| | - Erik Folch
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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30
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Levy EB, Fiel MI, Hamilton SR, Kleiner DE, McCall SJ, Schirmacher P, Travis W, Kuo MD, Suh RD, Tam AL, Islam SU, Ferry-Galow K, Enos RA, Doroshow JH, Makhlouf HR. State of the Art: Toward Improving Outcomes of Lung and Liver Tumor Biopsies in Clinical Trials-A Multidisciplinary Approach. J Clin Oncol 2020; 38:1633-1640. [PMID: 32134701 DOI: 10.1200/jco.19.02322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE National Cancer Institute (NCI)-sponsored clinical trial network studies frequently require biopsy specimens for pharmacodynamic and molecular biomarker analyses, including paired pre- and post-treatment samples. The purpose of this meeting of NCI-sponsored investigators was to identify local institutional standard procedures found to ensure quantitative and qualitative specimen adequacy. METHODS NCI convened a conference on best biopsy practices, focusing on the clinical research community. Topics discussed were (1) criteria for specimen adequacy in the personalized medicine era, (2) team-based approaches to ensure specimen adequacy and quality control, and (3) risk considerations relevant to academic and community practitioners and their patients. RESULTS AND RECOMMENDATIONS Key recommendations from the convened consensus panel included (1) establishment of infrastructure for multidisciplinary biopsy teams with a formalized information capture process, (2) maintenance of standard operating procedures with regular team review, (3) optimization of tissue collection and yield methodology, (4) incorporation of needle aspiration and other newer techniques, and (5) commitment of stakeholders to use of guideline documents to increase awareness of best biopsy practices, with the goal of universally improving tumor biopsy practices.
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Affiliation(s)
- Elliot B Levy
- Center for Interventional Oncology, Radiology and Imaging Sciences and Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - Maria I Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stanley R Hamilton
- Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Kleiner
- Laboratory of Pathology, National Institutes of Health, Bethesda, MD
| | | | - Peter Schirmacher
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - William Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Michael D Kuo
- Department of Radiology Medical Artificial Intelligence Laboratory Initiative, The University of Hong Kong, Hong Kong
| | - Robert D Suh
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Shaheen U Islam
- Division of Pulmonary, Critical Care & Sleep Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Katherine Ferry-Galow
- Laboratory of Human Toxicology and Pharmacology, Applied/ Developmental Research Support Directorate, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Hala R Makhlouf
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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Jiang T, Lin M, Zhao M, Zhan C, Li M, Feng M, Wang Q. Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye. Thorac Cardiovasc Surg 2020; 68:525-532. [PMID: 32114690 DOI: 10.1055/s-0039-3400999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study was aimed to describe a new localization technique developed using medical glue and methylene blue dye, and characterized the localization results and postoperative outcome to evaluate its safety and usefulness. METHODS This retrospective study was conducted at our center from January 2016 to April 2018. Totally 346 consecutive patients with 383 nodules who underwent preoperative computed tomography (CT)-guided medical glue and methylene blue dye localization, followed by lung resection, were enrolled in this study. RESULTS Mean nodule size was 7.7 ± 3.7 mm (range: 2-30 mm), with a mean depth from pleura or fissure of 9.4 ± 9.3 mm (range: 0-60 mm). The success rate of CT-guided localization for pulmonary nodules was 99.5% (381/383) of the nodules. Localization-related complications included mild pneumothorax in 16 (4.6%) patients, mild hemothorax in 7 (2.0%) patients, and hemoptysis in 1 (0.3%) patient. Pleural reaction occurred in 7 (2.0%) and pain in 25 (7.2%) patients. All 383 nodules were resected successfully, with conversion to thoracotomy only required in two patients for adhesion and calcification of lymph nodes. All patients recovered well postoperatively, with a short postoperative hospital stay (3.7 ± 2.0 days) and a low complication rate (2.6%, 9/346). CONCLUSION CT-guided medical glue and methylene blue dye localization prior to video-assisted thoracoscopic surgery (VATS) lung resection was a novel, safe, and technically feasible method, with a high-technical success rate and a low-complication rate. It allowed surgeons to easily locate and detect the nodules and estimate the surgical margin.
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Affiliation(s)
- Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Augmented fluoroscopic bronchoscopy (AFB) versus percutaneous computed tomography-guided dye localization for thoracoscopic resection of small lung nodules: a propensity-matched study. Surg Endosc 2020; 34:5393-5401. [PMID: 31932929 DOI: 10.1007/s00464-019-07334-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dye localization is a useful method for the resection of unidentifiable small pulmonary lesions. This study compares the transbronchial route with augmented fluoroscopic bronchoscopy (AFB) and conventional transthoracic CT-guided methods for preoperative dye localization in thoracoscopic surgery. METHODS Between April 2015 and March 2019, a total of 231 patients with small pulmonary lesions who received preoperative dye localization via AFB or percutaneous CT-guided technique were enrolled in the study. A propensity-matched analysis, incorporating preoperative variables, was used to compare localization and surgical outcomes between the two groups. RESULTS After matching, a total of 90 patients in the AFB group (N = 30) and CT-guided group (N = 60) were selected for analysis. No significant difference was noted in the demographic data between both the groups. Dye localization was successfully performed in 29 patients (96.7%) and 57 patients (95%) with AFB and CT-guided method, respectively. The localization duration (24.1 ± 8.3 vs. 21.4 ± 12.5 min, p = 0.297) and equivalent dose of radiation exposure (3.1 ± 1.5 vs. 2.5 ± 2.0 mSv, p = 0.130) were comparable in both the groups. No major procedure-related complications occurred in either group; however, a higher rate of pneumothorax (0 vs. 16.7%, p = 0.029) and focal intrapulmonary hemorrhage (3.3 vs. 26.7%, p = 0.008) was noted in the CT-guided group. CONCLUSION AFB dye marking is an effective alternative for the preoperative localization of small pulmonary lesions, with a lower risk of procedure-related complications than the conventional CT-guided method.
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Chen CK, Chang HT, Chen YC, Chiang SC, Chou HP, Chen TJ. Utilization and Safety of Percutaneous Lung Biopsy: A 10-Year Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081316. [PMID: 31013710 PMCID: PMC6517953 DOI: 10.3390/ijerph16081316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Percutaneous lung biopsy is a technique used for sampling peripherally located lung masses and has been gaining in popularity. However, its exact utilization is unknown, and its safety has not been well studied. The current study aimed to assess the trend of utilization and study the safety of this procedure. Using the National Health Insurance Research Database, we retrospectively determined the total number of procedures that were performed on subjects older than 20 years between 2001 and 2010. We also estimated the rates of major complications, such as pneumothorax, requiring intercostal drainage. A total of 630 percutaneous biopsies were performed in 2001, while 3814 were performed in 2010, representing a 6.1-fold increase. The compound annual growth rate was 22.1%. The number of hospitals that performed the procedure increased from 55 to 99. Pneumothorax requiring drainage occurred in 1.5% of the procedures. The factors associated with a higher complication rate included male gender, chronic obstructive pulmonary disease, rural hospital, and low-volume hospital. Percutaneous lung biopsies are a relatively safe procedure, and their performance has been rapidly increasing. The number of procedures performed by a hospital was associated with the complication rate.
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Affiliation(s)
- Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Radiology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Yu-Chun Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Hsiao-Ping Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Radiology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Division of Radiology, Yonghe Cardinal Tien Hospital, New Taipei City 23445, Taiwan.
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Department of Family Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
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