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EUS-B-FNA Enhances the Diagnostic Yield of EBUS Bronchoscope for Intrathoracic Lesions. Lung 2022; 200:643-648. [PMID: 36074142 DOI: 10.1007/s00408-022-00563-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Endobronchial ultrasound (EBUS) bronchoscopes have been used mainly through the airway for EBUS-guided transbronchial needle aspiration (EBUS-TBNA); however, they can also be used through the esophagus. The esophageal approach, endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA), has gradually become popular, as it can evaluate lesions that cannot be accessed through the airway. PURPOSE This study aimed to evaluate the value of adding EUS-B-FNA to EBUS-TBNA performed by pulmonologists for intrathoracic lesions in the clinical setting. METHODS Between March 2009 and March 2020, all patients who underwent EUS-B-FNA and EBUS-TBNA for diagnostic purposes were included and retrospectively analyzed at a single institution. RESULTS A total of 1794 procedures using an EBUS bronchoscope including, EBUS-TBNA, EUS-B-FNA, and the combination of EBUS-TBNA and EUS-B-FNA for evaluating intrathoracic lesions, were performed. We finally analyzed 276 patients who underwent EUS-B-FNA for diagnostic purposes. EUS-B-FNA provided diagnostic materials from only EBUS-TBNA-inaccessible lesions in 26 patients and in 18 patients whose conditions were inappropriate for bronchoscopy (e.g., respiratory failure, airway stenosis, etc.). EUS-B-FNA provided diagnostic results in four patients with non-diagnostic EBUS-TBNA results. EUS-B-FNA was preferable to EBUS-TBNA in 4.4% (48 of 1091) of patients; therefore, adding EUS-B-FNA to EBUS-TBNA increased the diagnostic yield from 72.6% (1043 of 1437) to 75.9% (1091 of 1437). CONCLUSION Pulmonologists are able to enhance diagnostic yields by acquiring the EUS-B-FNA technique.
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de Ruiter QMB, Fontana JR, Pritchard WF, Mauda-Havakuk M, Bakhutashvili I, Esparza-Trujillo JA, Varble NA, Verstege M, Xu S, Seifabadi R, Browning RF, Wood BJ, Karanian JW. Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance. Transl Lung Cancer Res 2021; 10:3627-3644. [PMID: 34584862 PMCID: PMC8435394 DOI: 10.21037/tlcr-21-275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endobronchial navigation is performed in a variety of ways, none of which are meeting all the clinicians' needs required to reach diagnostic success in every patient. We sought to characterize precurved and steerable guiding sheaths (GS) in endobronchial targeting for lung biopsy using cone beam computed tomography (CBCT) based augmented fluoroscopy (AF) image guidance. METHODS Four precurved GS (EdgeTM 45, 90, 180, 180EW, Medtronic) and two steerable GS [6.5 F Destino Twist (DT), Oscor; 6 F Morph, BioCardia] were evaluated alone and in combination with an electromagnetic tracking (EM) guide and biopsy needles in three experimental phases: (I) bench model to assess GS deflection and perform biopsy simulations; (II) ex vivo swine lung comparing 2 steerable and 2 precurved GS; and (III) in vivo male swine lung to deliver a needle (n=2 swine) or to deliver a fiducial marker (n=2 swine) using 2 steerable GS. Ex vivo and in vivo image guidance was performed with either commercial or prototype AF image guidance software (Philips) based on either prior CT or procedural CBCT. Primary outcomes were GS delivery angle (θGS) and needle delivery angle (θN) in bench evaluation and needle delivery error (mm) (mean ± se) for ex vivo and in vivo studies. RESULTS The steerable DT had the largest range of GS delivery angles (θN: 0-114°) with either the 21 G or 19 G biopsy needle in the bench model. In ex vivo swine lung, needle delivery errors were 8.7±0.9 mm (precurved Edge 90), 5.4±1.9 mm (precurved Edge 180), 4.7±1.2 mm (steerable DT), and 5.6±2.4 mm (steerable Morph). In vivo, the needle delivery errors for the steerable GS were 6.0±1.0 mm (DT) and 15±7.0 mm (Morph). In vivo marker coil delivery was successful for both the steerable DT and morph GS. A case report demonstrated successful needle biopsy with the steerable DT. CONCLUSIONS Endobronchial needle delivery with AF guidance is feasible without a bronchoscope with steerable GS providing comparable or improved accuracy compared to precurved GS.
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Affiliation(s)
- Quirina M. B. de Ruiter
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Joseph R. Fontana
- Pulmonary Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William F. Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michal Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Juan A. Esparza-Trujillo
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Nicole A. Varble
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Philips Research of North America, Cambridge, MA, USA
| | | | - Sheng Xu
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Reza Seifabadi
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Bradford J. Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Cancer Research, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - John W. Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
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