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Electromagnetic navigation bronchoscopy

Ze-Rui Zhao, Rainbow W H Lau, Peter S Y Yu, Randolph H L Wong, Calvin S H Ng
The advancement of imaging technology has recently facilitated single port minimally-invasive thoracic surgery techniques. Cone-beam computed tomography (CBCT) shows promising results in visualizing the target lesion and its surrounding critical anatomy, with an error of less than 2 mm. The integration of CBCT with the operating room (OR) to form the hybrid OR, provides unparalleled real-time imaging of the patient, which can be used with electromagnetic navigation bronchoscopy to confirm successful navigation and increase procedural accuracy particularly for small peripheral pulmonary targets...
October 2016: Journal of Thoracic Disease
Carlos Anciano, Craig Brown, Mark Bowling
The ability to reach the peripheral pulmonary nodule/mass with bronchoscopy has improved greatly over the past several years with the use of Electromagnetic navigational bronchoscopy; however, many of these lesions are unable to be adequately sampled due to their location outside the bronchial airways. We report the first use of the transbronchial access tool that creates a pathway from the bronchial airway through the lung parenchyma into the targeted lung abnormality.
December 21, 2016: Journal of Bronchology & Interventional Pulmonology
Roy W Semaan, Hans J Lee, David Feller-Kopman, Andrew D Lerner, Christopher M Mallow, Jeffrey Thiboutot, Sixto A Arias, Lonny B Yarmus
RATIONALE: Bronchoscopy is commonly used for the diagnosis of suspicious pulmonary nodules discovered on computed tomographic (CT) imaging of the chest. Procedural CT imaging for bronchoscopy planning is often completed weeks to months before the date of a scheduled bronchoscopy, which may not allow discovery of a decrease in nodule size or resolution before the bronchoscopic procedure. OBJECTIVES: To determine whether same-day CT imaging of the chest discovers partial or total resolution of some lung nodules and thereby reduces unnecessary bronchoscopic procedures...
December 2016: Annals of the American Thoracic Society
Geoff Nelson, Meng Wu, Cameron Hinkel, Ganesh Krishna, Tobias Funk, Jarrett Rosenberg, Rebecca Fahrig
PURPOSE: Electromagnetic navigation bronchoscopy (ENB) provides improved targeting accuracy during transbronchial biopsies of suspicious nodules. The greatest weakness of ENB-based guidance is the registration divergence that exists between the planning CT, acquired days or weeks before the intervention, and the patient on the table on the day of the intervention. Augmenting ENB guidance with real-time tomosynthesis imaging during the intervention could mitigate the divergence and further improve the yield of ENB-guided transbronchial biopsies...
December 2016: Medical Physics
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. METHODS: A single-center, single-operator retrospective chart review was performed on patients who underwent ENB for the diagnosis of pulmonary lesions...
January 2017: 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
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
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...
January 2017: 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
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
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
Mihir S Parikh, Eric Seeley, Ganesh Krishna
Surgical resection is traditionally the preferred treatment for fluorodeoxyglucose-avid peripheral pulmonary nodules that grow over time. However, new technologies, including electromagnetic navigational bronchoscopy (ENB), provide an opportunity to confirm or possibly exclude a cytologic cancer diagnosis, before resection. We present a case of a 56-year-old North American man who presented with a fluorodeoxyglucose-avid pulmonary nodule and sought a second opinion after being recommended thoracotomy with lobectomy...
April 11, 2016: Journal of Bronchology & Interventional Pulmonology
Lakshmi Mudambi, David E Ost
PURPOSE OF REVIEW: The review describes recent advances in bronchoscopic modalities used to diagnose peripheral pulmonary lesions. RECENT FINDINGS: The pooled diagnostic yield and sensitivity of radial probe endobronchial ultrasound (r-EBUS) has been reported to be 56% for lesions less than 2 cm and 78% for lesions more than 2 cm and 73%, respectively. The pooled diagnostic yield and sensitivity of electromagnetic navigational bronchoscopy (ENB) has been reported to be 65 and 71%, respectively...
July 2016: Current Opinion in Pulmonary Medicine
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