Pulmonary Procedures |

Triple-Needle Brush in the Diagnosis of Peripheral Pulmonary Nodules FREE TO VIEW

Michael Pritchett, MPH; Charles Schirmer
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Pinehurst Medical Clinic, Pinehurst, NC

Chest. 2014;146(4_MeetingAbstracts):796A. doi:10.1378/chest.1992469
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SESSION TITLE: Bronchoscopy Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: There are multiple biopsy instruments at the disposal of the bronchoscopist but a new tool called the triple-needle brush is distinctly different from previous instruments. The first report of a cytology “needle bush” being used is in the early 1990s created by Mill Rose Labs. Instead of having a blunt end it had a very sharp needle tip. Whereas normal brushes must follow the airway due to their blunt end, the needle brush can penetrate airway walls and help to reach lesions that do not have a direct nodule-to-airway relationship. The triple-needle cytology brush (superDimension) has three distinct needle-tipped brushes on the same tool that fans out upon deployment to encompass a wide radius and significantly increased surface area. The brush comes in 10mm and 15mm sizes.

METHODS: We utilized the 10mm superDimension triple-needle brush (TNB) in 6 cases of solitary pulmonary nodules. In all cases the lesions were reached using electromagnetic navigation bronchoscopy (ENB) with the superDimension iLogic system. The nodules ranged in size from 1cm-2.5cm. There were lesions in both the upper and lower lobes.

RESULTS: A positive diagnosis was made in 5 of 6 cases. In one particular case, the TNB was the only tool to achieve the diagnosis after transbronchial needle aspiration (TBNA) and standard brushings failed to yield diagnostic tissue samples. There was no significant bleeding or pneumothorax using the TNB in any of the cases.

CONCLUSIONS: The triple-needle brush is a safe and effective tool for diagnosing peripheral lung lesions.

CLINICAL IMPLICATIONS: Due to its sharp needle tips, the brush can penetrate airway walls and the tumor itself to improve access to the lesion. In addition, the use of three brushes on the same tool dramatically increases the surface area being sampled. We conclude that the triple-needle brush is an excellent addition to existing tools for the diagnosis of peripheral lung lesions and may, in fact, improve diagnostic yield.

DISCLOSURE: Michael Pritchett: Consultant fee, speaker bureau, advisory committee, etc.: Speaker fees Charles Schirmer: Consultant fee, speaker bureau, advisory committee, etc.: speaker fees

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