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Pulmonology Procedures |

Accuracy of Navigational Bronchoscopy in a Patient With a Shoulder Prosthesis

Sivaraman Sivaswami*, MBBS; Adam Wellikoff, MD; Robert Holladay, MD
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Lousiana State University Health Sciences Center, Shreveport, LA


Chest. 2012;142(4_MeetingAbstracts):911A. doi:10.1378/chest.1388295
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Abstract

SESSION TYPE: Bronchoscopy and Interventional Procedures Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To demonstrate the accuracy of navigational bronchoscopy in a patient with a metallic shoulder prosthesis.

METHODS: A 91 year old Caucasian male with a 2 x 2.3 cm left upper lobe mass and left shoulder prosthetic implant underwent a chest CT scan with navigational protocol (0.625mm slices with 1 mm overlap). The CT scan images were imported into the system software. Multiple registration points including the target were marked and a pathway to the target was planned. The patient was taken to the bronchoscopy suite where, after lying supine on the electromagnetic board and placement of three sensors on his chest for motion compensation, bronchoscopy was commenced. The corresponding anatomic points were touched by the locator probe to register the actual anatomic point with the corresponding point on the virtual bronchoscopy view constructed from the Chest CT scan. The system is built to disallow registration if there is excessive electromagnetic interference, abnormal lung anatomy, excessive CT to body divergence greater than 10mm or insufficient protrusion of the locator guide from the bronchoscope. Navigation to the target was successful. The locator probe was removed from the extended working channel and biopsies from the lesion were obtained using biopsy forceps.

RESULTS: Transbronchial biopsy yielded a poorly differentiated adenocarcinoma with extensive necrosis. Cytokeratin (AE 1/3) and TTF-1 immunostains were confirmatory. EGFR mutation was negative. The cytology of the bronchial washings was also positive for adenocarcinoma.

CONCLUSIONS: Presence of an ipsilateral metallic shoulder prosthesis did not impede successful electromagnetic navigational bronchoscopy. The size of the lesion and the presence of an airway to the lesion determined succesful outcome in this case. The distortion in the electromagnetic field caused by the metallic prosthesis was effectively compensated for by the navigational bronchoscopy software.

CLINICAL IMPLICATIONS: Navigational bronchoscopy should not be withheld in patients with metallic shoulder prostheses.

DISCLOSURE: The following authors have nothing to disclose: Sivaraman Sivaswami, Adam Wellikoff, Robert Holladay

No Product/Research Disclosure Information

Lousiana State University Health Sciences Center, Shreveport, LA

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