Efficacy and Safety of Cone-Beam CT Augmented Electromagnetic Navigation Guided Bronchoscopic Biopsies of Indeterminate Pulmonary Nodules

Abstract

Bronchoscopic biopsy results for indeterminate pulmonary nodules remain suboptimal. Electromagnetic navigation bronchoscopy (ENB) coupled with cone beam computed tomography (CBCT) for confirmation has the potential to improve diagnostic yield. We present our experience using this multimodal approach to biopsy 17 indeterminate nodules in 14 consecutive patients from April to August 2021. Demographic information, nodule characteristics, and biopsy results were recorded. Procedures were performed in a hybrid operating room equipped with a Siemens Artis Q bi-plane CBCT (Siemens, Munich, Germany). After ENB using the superDimension version 7.1 (Medtronic, Plymouth, MN, USA) to target the lesion, radial endobronchial ultrasound was used as secondary confirmation. Next, transbronchial needle aspiration was performed prior to CBCT to evaluate placement of the biopsy tool in the lesion. The average nodule size was 21.7+/−15 mm with 59% (10/17) < 2 cm in all dimensions and 35% (6/17) showing a radiographic bronchus sign. The diagnostic yield of CBCT-guided ENB was 76% (13/17). No immediate periprocedural or postprocedural complications were identified. Our experience with CBCT-guided ENB further supports the comparable efficacy and safety of this procedure compared to other mature biopsy modalities. Studies designed to optimize the lung nodule biopsy process and to determine the contributions from different procedural aspects are warranted.

Performance of radial endobronchial ultrasound for peripheral pulmonary lesions without automation technology in tuberculous endemic region: real-world experience in a single institution over 6 years

“…Although GGO nodules can be localized by rEBUS through the identification of blizzard sign, it requires training and experience ( 37 ). Advancement in real-time imaging systems such as C-arm-based digital tomosynthesis and cone-beam CT may complement rEBUS in localizing GGO in the future ( 38 , 39 ). Thirdly, our study had a 6-month follow-up period for subjects with inflammatory biopsy result to establish a definitive diagnosis.…”

Endoscopic Technologies for Peripheral Pulmonary Lesions: From Diagnosis to Therapy

“…Multiple companies have developed their version of both portable and fixed CBCT systems [ 111 , 114 , 115 , 116 , 117 , 118 ]. When considering using CBCT, physicians should remember that this technique causes significant radiation exposure, needs a complex workflow, and lengthens the procedural time [ 111 ].…”

Imaging in peripheral bronchoscopy

“…Most publications on CBCT-guided bronchoscopy employed fixed CBCT systems, however, data on bronchoscopy specifically using mobile CBCT guidance are similarly promising [24,25]. The success of CBCT-guided bronchoscopy does not appear to be associated with target-specific factors, such as lobar location or absence of a bronchus sign [26,27,28 ▪ ]. Although studies directly comparing CBCT-guided bronchoscopy to other bronchoscopic methods are limited in number, single-center studies have demonstrated significantly better diagnostic outcomes when CBCT guidance is added to EMN or ultrathin bronchoscopy with rEBUS than with either EMN or rEBUS alone [28 ▪ ,29,30].…”