Bronchoscopic Transparenchymal Nodule Access: Feasibility and Safety in an Endoscopic Unit

Abstract

Background: The minimal invasive investigation of solitary pulmonary nodules becomes increasingly important with the emergence of lung cancer screening. Objectives: We report the results of the first utilization of a recently developed procedure in a bronchoscopy suite, which approaches solitary pulmonary nodules via a transparenchymal path. Methods: This study was a prospective, single-arm interventional study. We investigated patients with a solitary pulmonary nodule detected on CT imaging, which was suspicious for malignancy. The subject's CT was employed to calculate an airway wall point of entry (POE) as well as an avascular path through lung tissue from the POE to the solitary pulmonary nodule. Using a set of catheter-based tools under fused fluoroscopy guidance, a tunnelled tract was created from the POE to the nodule. The patients were surveyed for at least 72 h in our hospital. The primary end point of the study was to evaluate the feasibility to access and biopsy solitary pulmonary nodules outside of an operation theatre. Results: Six patients were recruited, and a tunnel pathway was created in 5 patients. There were no adverse events during the procedures. Two pneumothoraces were diagnosed by chest X-ray 2 h after the procedure, with one pneumothorax requiring drainage. Adequate biopsies were obtained from all 5 patients in whom a tunnel path was created. Conclusions: This study demonstrates that bronchoscopic transparenchymal access of solitary pulmonary nodules is feasible outside an operation theatre.

Safety and diagnostic performance of pulmonologists performing electromagnetic guided percutaneous lung biopsy (SPiNperc)

“…Complication rates of 38.8% for core biopsies and 24% for FNA from radiologists performing CT‐guided percutaneous lung biopsy were reported in a recent meta‐analysis . Another new approach to diagnosing these lesions includes bronchoscopic transparenchymal biopsies, in which pilot studies have shown to have a diagnostic yield of 83%, although with a higher pneumothorax rate (up to 33%) . A combined procedural approach for the diagnosis of pulmonary nodules by attempting a bronchoscopic diagnosis first to limit complications, followed by a percutaneous biopsy if the bronchoscopy is non‐diagnostic, may be effective in limiting overall complications and increasing diagnostic yield.…”

Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield

“…If the lesion is extrabronchial, we suggest switching to other means of airway exploration that enable taking deeper biopsies, including PPLs located on the outside of the airway wall. Currently used candidate approaches include rEBUS [17, 23] (which allows insertion of larger forceps through the guide-sheath than can be inserted through the working channel of the UTB), VBN-guided fine-needle aspiration [24] (which can obtain blind cytobiopsies after an extrabronchial lesion is located with the VBN system), or transparenchymal nodule access [25, 26] (which could also be used for approaching lesions when segmentation is suboptimal since a straight path could be taken from the end of the segmented airway to the PPL). Although mini-cryobiopsy probes are not commercially available yet, it is thought that they can potentially obtain tissue surrounding distal bronchi [27].…”

Lung Nodule Management: An Interventional Pulmonology Perspective

“…Another small safety and feasibility study showed a 100% concordance rate between biopsies obtained by BTPNA and final pathology results in resected specimens. 43 However, a pneumothorax was identified in two out of the six patients, one of whom required chest tube insertion. The tunnel length did not correlate with pneumothorax risk.…”