PURPOSE: To evaluated impact of LungPoint Virtual Bronchoscopic (VB) Navigation system on sampling of pulmonary nodules.
METHODS: Enrolled subjects were consecutive patients with pulmonary lesions which were deemed difficult for conventional bronchoscopic sampling or had a negative conventional bronchoscopy. Most of these patients were poor candidates for surgical resection. The LungPoint VB system (Broncus Technologies) was utilized to produce a pathway to the target lesion(s). VB images were displayed alongside and synchronized with real-time bronchoscopic video. The bronchoscope was advanced along this pathway with real-time guidance. In some cases a guide sheath (Olympus Inc.) with or without peripheral ultrasound via a radial EBUS probe (Olympus Inc.) was then advanced to the target lesion under fluoroscopy. Brushings, transbronchial biopsies and bronchoalveolar lavage were then performed through the bronchoscope or guide sheath under fluoroscopy to obtain samples.
RESULTS: Study subjects included 39 patients with 52 lesions (18 females), mean age 63 years. Median lesion size was 19.5 mm (range 6 mm-43mm), median distance from the pleura was 14 mm. Median procedure time was 60 minutes/patient. Pneumothorax occurred in four patients (10%). Eighteen lesions were diagnosed by bronchoscopy as malignant. A benign diagnosis was found in 12 lesions. Results were non-diagnostic in 22/52 cases (42%). Out of these, 4 (17%) were confirmed to be benign on serial radiographic follow up. Three were resected; 2 were benign and one malignant. One lesion was malignant on trans-thoracic CT-guided needle aspiration. Fourteen were treated as presumed malignancies. Sensitivity for diagnosing malignancy was 53%, specificity was 100 %, negative predictive value was 53%, and accuracy was 69%.
CONCLUSIONS: The LungPoint navigation system is useful for guidance to smaller and more peripheral pulmonary lesions and may help increase the yield of bronchoscopy in diagnosing pulmonary nodules.
CLINICAL IMPLICATIONS: The LungPoint navigation system may replace standard bronchoscopy in diagnosing pulmonary nodules. Further research is needed to compare the two methods.
DISCLOSURE: The following authors have nothing to disclose: Ragheed Alturkmani, Firas El Mufdi, Michael Jantz
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