Author of

• 12759

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  P3.17 - Poster Session 3 - Bronchoscopy, Endoscopy (ID 185)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12767

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    P3.17-008 - Electromagnetic Navigation Bronchoscopy increases diagnostic yield after non-diagnostic Endobronchial Ultrasound Guide Sheath for peripheral pulmonary lesions (ID 3226)

    09:30 - 09:30  |  Author(s): S. Leong
    • Abstract

    Background
    Peripheral pulmonary lesions (PPLs) are diagnostic challenges. Computed tomography guided transthoracic needle aspiration (CT TTNA) has high diagnostic sensitivity but also high complication rates[1]. Endobronchial ultrasound guide sheath (EBUS GS) allows confirmation of target localisation but cannot provide guidance to the target. Electromagnetic navigation bronchoscopy (ENB) allows the bronchoscopist to navigate to target without direct vision. We assessed whether ENB could diagnose PPLs that had undergone a non-diagnostic EBUS GS.

    Methods
    We performed 50 ENB procedures for diagnosis of PPLs between 3/2011-6/2013, 15 after non-diagnostic EBUS GS. ENB data was prospectively collected. ENB (superDimension, Minneapolis, US) was performed through a standard 5.9mm bronchoscope under general anaesthesia through a laryngeal mask airway after pathway planning using iLogic software. Once the locatable guide was close to and correctly aligned with the target, it was removed and replaced by EBUS radial probe (EBUS RP) to confirm target localisation. Samples were then taken with forceps biopsy, cytology brush, and mini bronchoalveolar lavage. If ENB was non-diagnostic patients underwent further investigation. Benign diagnoses were followed up for a minimum of 6 months to ensure a consistent clinical course. Primary outcome was diagnostic yield, procedure time, and complications. Characteristics distinguishing diagnostic from non-diagnostic ENB were assessed using the chi-squared test.

    Results
    15 patients (mean age 66.67, 9 females, 12 current or ex smokers, mean BMI 25.16kg/m2) with 15 PPLs who underwent non-diagnostic EBUS GS proceeded onto ENB. Lesion location and characteristics were as follows: left (7), upper lobe/lower lobe=11/4, bronchus sign positive (14), soft tissue density/ground glass=14/1. Mean maximal lesion dimension was 25.64mm+/- 12.38mm and mean closest distance from pleura was 12.04mm +/- 12.18mm. Average total procedure time was 56.83 mins +/- 13.71mins with a mean of 4.53 biopsies taken per patient. All except one procedure was performed under general anaesthesia with a laryngeal mask airway. The target was reached in 12 patients. Median closest distance to target was 12.69mm +/- 7.83mm. Target localisation was confirmed on EBUS RP without any manipulation in 10 patients; a further 2 lesions could be localised with minor manipulation. ENB provided a diagnosis in 5 of 15 patients (33.33%): adenocarcinoma (2), squamous cell carcinoma (1), fungal infection (1), organising pneumonia (1). Non-diagnostic ENB underwent the following additional procedures: CT TTNA (7), repeat EBUS GS (1), and surgical biopsy (2). The following conditions were diagnosed: mycobacterial infection (1), adenocarcinoma (4), fibrosis (1), hamartoma (1), non-small cell carcinoma (1), nodular lymphoid hyperplasia (1). There were no complications. Procedural success was independent of lesion size (p=0.378), location (p=0.714), or morphology (p=0.464), but was related to confirmation on EBUS RP without manipulation (p=0.053), and the ability to view the lesion on Maximal Intensity Projection (MIP) view in 360 degrees (p=0.053).

    Conclusion
    ENB can successfully diagnose PPLs that have been non-diagnostic on EBUS GS. Lesions that can be confirmed on EBUS GS after being navigated to by ENB, as well as those that can be visualised in 360 degrees on MIP view, have a higher chance of success.