Mobile 3-dimensional (3D) C-arm system-assisted transbronchial biopsy and ablation for ground-glass opacity pulmonary nodules: a case report

Abstract

Identification of pulmonary ground-glass opacity (GGO) lesions during bronchoscopic procedures remains challenging, as GGOs cannot be directly visualized under 2-dimensional (2D) fluoroscopy and are often difficult to detect by radial endobronchial ultrasound. Recently, a mobile 2D/3D C-arm fluoroscopy system was developed that provides both 2D fluoroscopy and mobile 3D imaging to assess and confirm the location of the lesions and ancillary bronchoscopic tools. However, previous studies focused mainly on experience of utilizing mobile 3D C-arm system for transbronchial biopsy of solid pulmonary nodules. Here, we evaluated the feasibility of mobile 3D imaging assisted transbronchial biopsy with and without ablation of two patients with GGO nodules. The first patient underwent biopsy only, and the second patient underwent biopsy in the right upper lobe lung nodule and ablation of a left upper lobe lung nodule in one session. Procedures in both patients were successfully performed, and no significant complications have been observed intra-or post-procedurally. Our case study highlights the potential value of the mobile 3D imaging system in accurate identification of the target lung lesion, confirmation of bronchoscopic tools within the lesion, and assessment of the target lesion and surrounding tissue following bronchoscopic ablation procedure. Furthermore, a "one-stop shop" bronchoscopy workflow combining both biopsy and ablation for one or more lung lesions in one session could be made possible by utilizing a hybrid mobile 2D/3D C-arm system in the bronchoscopy suite.

Robotic bronchoscopy and future directions of interventional pulmonology

“…Until recently, the use of navigation bronchoscopy to guide flexible ablation probes to the lung periphery had been suboptimal in part due to limitations of localization and in part due to difficulties using rigid probes. Case series describing advanced navigation technologies coupled with MWA and RFA flexible probes have been recently described and are being further investigated [37 ▪ ,38 ▪ ]. Utilizing experience with percutaneous ablation, the efforts in bronchoscopic peripheral ablation now center on confirmation of the location (i.e., tool-in-lesion) by the use of confirmatory imaging (i.e., CBCT or 3D fluoroscopy) as well as confirmation of the ablation zone.…”

Mobile 3-dimensional C-arm system–assisted localization and resection of pulmonary nodules: a case description

“…Both Avasarala et al ( 8 ) and Sadoughi et al ( 7 ) reported successful transbronchial biopsy of lung nodules using a mobile 3D C-arm system. Chen et al ( 9 ) demonstrated the feasibility and clinical value of the mobile 3D C-arm system for assisting transbronchial biopsy and ablation of GGN lesions. Although Hsieh et al ( 10 ) were the first to report clinical experience with the mobile 3D C-arm system for preoperative pulmonary nodule localization, our team improved the process by using a series of more optimized localization protocols.…”

Chinese expert consensus on cone‐beam CT‐guided diagnosis, localization and treatment for pulmonary nodules

“…Although the mobile CBCT system has disadvantages over the fixed CBCT system in terms of scanning speed, image quality and imaging range, it is adequate for most interventions for pulmonary nodules. Whether in biopsy, localization, or ablation, the mobile CBCT can conveniently provide real‐time 3D images to identify the relationship between tools and target lesion 25,30,73–75 . Some ground‐glass opacity nodules may be difficult to visualize due to the presence of instruments such as metal markers or needles in the surrounding area 28 .…”

“…In transbronchial or percutaneous transthoracic procedures, CBCT (with fixed C‐arm or mobile C‐arm) delineates positions of the target lesion and the tool in real time, and provides fluoroscopic monitoring during the procedure 25–27 . In ablation procedures, CBCT can also be used for treatment monitoring and evaluating ablation efficacy 28–30 . Some CBCT systems can provide augmented fluoroscopy to guide the tools to target lesions 31–33 .…”