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Navigational bronchoscopy

Ze-Rui Zhao, Zheng Li, Dong-Rong Situ, Calvin S H Ng
The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS...
August 2016: Journal of Thoracic Disease
Sumit Mukherjee, Michael Chacey
BACKGROUND: Electromagnetic navigation bronchoscopy (ENB) may aid in the diagnosis of solitary pulmonary lesions with a lower complication rate than conventional diagnostic modalities. A curved-tip catheter is now available for use with ENB; however, the diagnostic yield of this device has not been previously reported. MATERIALS AND METHODS: A single-center, single-operator retrospective chart review was performed on patients who underwent ENB for the diagnosis of pulmonary lesions...
September 10, 2016: Journal of Bronchology & Interventional Pulmonology
Aditya Goud, Chanukya Dahagam, David P Breen, Saiyad Sarkar
The incidence of pulmonary nodules and lung cancer is rising. Some of this increase in incidence is due to improved pick up by newer imaging modalities. However, the goal is to diagnose these lesion, many of which are located in the periphery, by safe and relatively non-invasive methods. This has led to the emergence of numerous techniques such as electromagnetic navigational bronchoscopy (ENB). Current evidence supports a role for these techniques in the diagnostic pathway. However, numerous factor influence the diagnostic accuracy...
July 2016: Journal of Thoracic Disease
Masanori Yasuo, Takashi Kobayashi, Mineyuki Hama, Takashi Ichiyama, Toshimichi Horiuchi, Hiroshi Yamamoto, Satoshi Kawakami, Kazutoshi Hamanaka, Takayuki Honda, Masayuki Hanaoka
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is frequently applied to the diagnosis of central airway lesions, and endobronchial ultrasound with a guide sheath (EBUS-GS) is mainly used for the diagnosis of peripheral pulmonary lesions. However, there remains an unmet need to improve the diagnostic yields for peribronchial pulmonary lesions located along the secondary/tertiary and fourth/fifth bronchi (the "middle third zone" of the lungs), which neither EBUS-TBNA nor EBUS-GS can easily approach...
September 2016: Respiratory Investigation
Joshua C Anderson, Douglas J Minnich, M Christian Dobelbower, Alexander J Denton, Alex M Dussaq, Ashley N Gilbert, Timothy D Rohrbach, Waleed Arafat, Karim Welaya, James A Bonner, Christopher D Willey
[This corrects the article DOI: 10.1371/journal.pone.0116388.].
2016: PloS One
Fumihiro Asano
Bronchoscopy to examine peripheral pulmonary lesions is performed using a bronchoscope with an outer diameter of 5-6mm under fluoroscopy, but the diagnostic yield can be insufficient. Problems with transbronchial biopsy include a limited range of bronchoscope insertion, difficulty in guiding a bronchoscope and biopsy instruments to lesions, and insufficient confirmation of the arrival of biopsy instruments at the target lesion; as such, new techniques have been used to overcome these individual problems. Radial-endobronchial ultrasound is used to identify peripheral pulmonary lesions and sampling sites...
July 2016: Respiratory Investigation
Guler Ozgul, Erdogan Cetinkaya, Mehmet Akif Ozgul, Yasin Abul, Atayla Gencoglu, Emine Kamiloglu, Sule Gul, H Erhan Dincer
BACKGROUND AND OBJECTIVES: Electromagnetic navigation bronchoscopy (ENB) is a promising new technology to increase the diagnostic yield of peripheral lung and mediastinal lesions. Conventional flexible bronchoscopy has a limited yield in peripheral pulmonary lesions, even in experienced hands. Radial endobronchial ultrasound (r-EBUS) with its real-time imaging capability can help to diagnose peripheral pulmonary lesions. In the present study, we aimed to investigate the diagnostic yield and safety of ENB with or without r-EBUS for peripheral lung lesions...
May 2016: Endoscopic Ultrasound
Shotaro Okachi, Naoyuki Imai, Kazuyoshi Imaizumi, Shingo Iwano, Masahiko Ando, Tetsunari Hase, Hiromichi Aso, Masahiro Morise, Keiko Wakahara, Satoru Ito, Naozumi Hashimoto, Mitsuo Sato, Masashi Kondo, Yoshinori Hasegawa
Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy...
2016: Internal Medicine
Ilya G Berim, Albert Naveed, Freshta Sahak
Two peripheral lung nodules suspicious for lung cancer were noted in a patient. Surgical and CT-guided transthoracic needle biopsies were deemed to be high risk given advanced emphysema. The patient received nondiagnostic electromagnetic navigation bronchoscopy and endobronchial ultrasound (EBUS)-guided mediastinal needle biopsies. Repeat bronchoscopy was then performed. The lung nodules were difficult to visualize with both convex probe EBUS and electromagnetic navigation bronchoscopy guidance. Normal saline injection into vicinity of the peripheral lung nodule was then used in hopes of filling airspace with fluid and improving visualization of the lung nodule...
June 29, 2016: Journal of Bronchology & Interventional Pulmonology
Pietro Nardelli, Alexander Jaeger, Conor O'Shea, Kashif A Khan, Marcus P Kennedy, Pádraig Cantillon-Murphy
PURPOSE: Lung cancer still represents the leading cause of cancer-related death, and the long-term survival rate remains low. Computed tomography (CT) is currently the most common imaging modality for lung diseases recognition. The purpose of this work was to develop a simple and easily accessible virtual bronchoscopy system to be coupled with a customized electromagnetic (EM) tracking system for navigation in the lung and which requires as little user interaction as possible, while maintaining high usability...
June 21, 2016: International Journal of Computer Assisted Radiology and Surgery
Harman Kular, Lakshmi Mudambi, Donald R Lazarus, Lorraine Cornwell, Angela Zhu, Roberto F Casal
BACKGROUND: Stereotactic body radiation therapy (SBRT) is considered the standard treatment for medically inoperable early stage lung cancer. Bronchoscopy has shown to be effective in obtaining diagnosis of peripheral lung tumors, staging the mediastinum (with endobronchial ultrasound- EBUS-), and placing fiducial markers (FMs). However, the combination of these 3 procedures in a single bronchoscopy has not been studied. The aim of this study is to describe safety and feasibility of performing diagnosis, systematic nodal staging, and placement of FMs in a single bronchoscopic procedure...
June 2016: Journal of Thoracic Disease
Min A Kwon, Jaegyok Song, Seokkon Kim, Seong-Mi Ji, Jeongho Bae
BACKGROUND: Various complications may occur during nasotracheal intubation. This may include epistaxis and damage to the nasopharyngeal airway. We tested the hypothesis that the use of fiberoptic bronchoscopy (FOB)-guided intubation is superior to endotracheal tube (ETT) obturated with an inflated esophageal stethoscope. METHODS: Patients were randomly assigned to 1 of 2 groups (n=22 each): either an FOB-guided intubation group or ETT obturated with an inflated esophageal stethoscope group...
August 2016: Journal of Clinical Anesthesia
Thomas L Bauer, David B Berkheim
The bronchoscope has gone through much advancement from its origin as a thin metal tube. It has become a highly sophisticated tool for clinicians. Both rigid and the flexible bronchoscopes are invaluable in the diagnosis and treatment of non-small cell lung cancer. Treatment of this disease process hinges on accurate diagnosis and lymph node staging. Technologies, such as endobronchial ultrasound, navigational bronchoscopy, and autofluorescence, have improved efficacy of endobronchial diagnosis and sample collection...
July 2016: Surgical Oncology Clinics of North America
Felix Jf Herth, Ralf Eberhardt, Maren Schuhmann
INTRODUCTION: More than 150,000 solitary pulmonary nodules are reported each year in the United States. As the popularity of low dose CT scan use for screening grows, these numbers are likely to increase substantially over the coming years. More than 10 million CT scans of the chest were performed in the United States alone in 2012, highlighting the potential for this clinical scenario. Detecting a nodule on either a chest radiograph or a CT scan frequently leads to a cascade of further investigations to establish a definite diagnosis...
August 2016: Expert Review of Respiratory Medicine
Katy A Marino, Jennifer L Sullivan, Benny Weksler
BACKGROUND: Pulmonary nodules smaller than 1 cm can be difficult to identify during minimally invasive resection, necessitating conversion to thoracotomy. We hypothesized that localizing nodules with electromagnetic navigation bronchoscopy and marking them with methylene blue would allow minimally invasive resection and reduce conversion to thoracotomy. METHODS: We retrospectively identified all patients who underwent electromagnetic navigation bronchoscopy followed by minimally invasive resection of a pulmonary nodule from 2011 to 2014...
August 2016: Annals of Thoracic Surgery
Omar Awais, Michael R Reidy, Kunal Mehta, Valentino Bianco, William E Gooding, Matthew J Schuchert, James D Luketich, Arjun Pennathur
BACKGROUND: Computed tomography scans are increasingly used not only for lung cancer screening but also for staging and evaluation of other cancers. As a result, more patients with pulmonary nodules, many with subcentimeter lesions, are being referred to thoracic surgeons, some with concern for primary lung neoplasm and others with possible metastatic lung lesions. Obtaining a definitive diagnosis of these lesions is difficult. Electromagnetic navigational bronchoscopy (ENB)-guided pleural dye marking followed by thoracoscopic resection is a novel alternative technique for definitive diagnosis...
July 2016: Annals of Thoracic Surgery
Erik E Folch, Mark R Bowling, Thomas R Gildea, Kristin L Hood, Septimiu D Murgu, Eric M Toloza, Momen M Wahidi, Terence Williams, Sandeep J Khandhar
BACKGROUND: Electromagnetic navigation bronchoscopy (ENB) procedures allow physicians to access peripheral lung lesions beyond the reach of conventional bronchoscopy. However, published research is primarily limited to small, single-center studies using previous-generation ENB software. The impact of user experience, patient factors, and lesion/procedural characteristics remains largely unexplored in a large, multicenter study. METHODS/DESIGN: NAVIGATE (Clinical Evaluation of superDimension™ Navigation System for Electromagnetic Navigation Bronchoscopy) is a prospective, multicenter, global, cohort study...
April 26, 2016: BMC Pulmonary Medicine
Satish Kalanjeri, Thomas R Gildea
Electromagnetic navigational bronchoscopy is a useful addition to the array of modalities available to sample peripheral lung lesions. Its utility in diagnosing peripheral lesions has been steadily increasing since the Food and Drug Administration first approved it in 2004. The improvement can be attributed to continuous refinement in technology, increasing training and experience with the procedure, perhaps widespread availability of rapid onsite cytologic evaluation, and better patient selection. It may also be attributable to improvements of the technology and more available tools to perform biopsy of the peripheral lung...
May 2016: Thoracic Surgery Clinics
Biniam Kidane, Kazuhiro Yasufuku
Different modalities of surgical excisional biopsy can be used when needle biopsy fails to provide tissue diagnosis. These modalities include intraoperative localization techniques, such as ultrasonography, and preoperative localization techniques, such as liquid dyes, radiolabeled aggregates, hook wires, microcoils, and navigational bronchoscopy techniques. The highest level of evidence for efficacy currently appears to support microcoils, radiolabeling, and hook-wire localization techniques. Multiple methods have been used to help identify intersegmental planes to facilitate minimally invasive segmental resection...
May 2016: Thoracic Surgery Clinics
Kashif Ali Khan, Pietro Nardelli, Alex Jaeger, Conor O'Shea, Padraig Cantillon-Murphy, Marcus P Kennedy
Peripheral lung nodules remain challenging for accurate localization and diagnosis. Once identified, there are many strategies for diagnosis with heterogeneous risk benefit analysis. Traditional strategies such as conventional bronchoscopy have poor performance in locating and acquiring the required tissue. Similarly, while computerized-assisted transthoracic needle biopsy is currently the favored diagnostic procedure, it is associated with complications such as pneumothorax and hemorrhage. Video-assisted thoracoscopic and open surgical biopsies are invasive, require general anesthesia and are therefore not a first-line approach...
April 2016: Advances in Therapy
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