PURPOSE: Real-time image-guidance improves bronchoscopies’ diagnostic accuracy, it's especially helpful for focal lesions suspicious for malignancies, when tumor staging by simultaneous sampling of multiple lesions or lymph nodes will affect treatment planning. CT-guided bronchoscopy can improve steering towards and confirmation of target sampling.
METHODS: Retrospective review of CT-fluoroscopy guided bronchoscopies performed for suspected cancers, at Johns Hopkins from November 2003 to March 2007. 23 cases were performed by one attending (RCY). Patients include 15 females and 8 males, ages 32–83 (mean 65); 11/23 had prior cancers; 21/23 used tobacco; 11/23 had COPD, 6 severe. 16/23 patients have multiple, 4 with bilateral lesions. 30 parenchymal and 11 mediastinal/hilar lymph nodes identified as potential targets; 14/30 parenchymal lesions <2cm. 4/23 patients had previous non-diagnostic bronchoscopies. Given the peripheral nature of many lesions, thin (4mm outer diameter BF-MP160F) and ultrathin (2.8mm BF-XP160) bronchoscopes were used in 13 and 4 cases respectively.
RESULTS: Tissue diagnosis include 18 separate cancer lesions, 6 malignant lymph nodes, 1 aspergilloma, 1 sarcoid lymph node diagnosed in 16 patients. 2 true negatives with benign lesions on f/u surgeries. There were 4 false negatives, 3 parenchymal cancers, 1 node diagnosed at surgery. 1 f/u pending, and 1 patient refused f/u. Diagnosis accurately achieved in 78% of patients, false-negative rate of 17% for cancers and remainder undetermined to date. In addition to sampling, barium markers were deposited in two patients with small ground glass peripheral lesions to guide VATS biopsies. Adverse events: 2 premature terminations, one each of supra-ventricular tachycardia and patient agitation; no major AEs nor pneumothorax.
CONCLUSION: In a bronchoscopy practice (1,100 cases/year), with available planar fluoroscopy, electromagnetic navigation (superDimension), CT-guided bronchoscopies are reserved for challenging cases (<1%). Overall diagnostic yield is good, and can be improved by use of thin bronchoscopes.
CLINICAL IMPLICATIONS: CT-fluoroscopy guided bronchoscopy should be considered in diagnosing multiple lesions, including bilateral lesions and in frail patients. Adjuncts to therapy include placing markers to guide surgery and radiotherapy, and in future direct intra-lesional injections.
DISCLOSURE: Rex Yung, No Financial Disclosure Information; No Product/Research Disclosure Information