Pulmonary Procedures |

Cone-Beam CT Scanning With Electromagnetic Navigation Bronchoscopy FREE TO VIEW

Michael Pritchett, MPH
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Pinehurst Medical Clinic, Pinehurst, NC

Chest. 2014;146(4_MeetingAbstracts):728A. doi:10.1378/chest.1994043
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SESSION TITLE: Bronchoscopy Posters I

SESSION TYPE: Original Investigation Poster

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

PURPOSE: Electromagnetic Navigation Bronchoscopy (ENB) has been shown to have superior yield in diagnosing peripheral nodules compared to conventional bronchoscopy. Standard fluoroscopy is most commonly used during these procedures to assist in visualization. Cone-beam CT (CBCT) is increasingly utilized by interventional radiology for percutaneous biopsy, placement of fiducials and application of ablative therapy for lung malignancies. There has been no study with the use of ENB and CBCT used in conjunction.

METHODS: We performed ENB using the superDimension iLogic system in conjunction with a 90-degree Edge catheter. After successful navigation to the lesion a brush was deployed for sampling. With the brush extending in the sampling position, a rotational scan was performed to acquire the cone-beam CT images using the Philips Allura Xper FD20 system.

RESULTS: The images were manipulated for immediate viewing, which showed the brush in the center of the 1cm lesion. Rapid on-site pathologic evaluation showed evidence of a moderately differentiated adenocarcinoma. Due to advanced lung disease and other comorbidities, the patient was not an appropriate surgical candidate and was therefore referred for stereotactic body radiation therapy (SBRT).

CONCLUSIONS: To the best of our knowledge this is the first use of CBCT in conjunction with ENB in humans.

CLINICAL IMPLICATIONS: Recent case studies have shown increasing use of CBCT with conventional bronchoscopy, using CBCT itself as a mode of navigation. We feel that these two modalities used in combination have significant potential to both increase diagnostic yield and eventually to confirm location for use of endobronchial-guided ablative therapies for early-stage lung cancer, such as radiofrequency or microwave ablation.

DISCLOSURE: Michael Pritchett: Consultant fee, speaker bureau, advisory committee, etc.: Honorarium for speaking

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