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Original Research: Pulmonary Procedures |

The Effect of Respiratory Motion on Pulmonary Nodule Location During Electromagnetic Navigation BronchoscopyNodule Movement With Navigation Bronchoscopy

Alexander Chen, MD; Nicholas Pastis, MD, FCCP; Brian Furukawa, MD; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Chen), Washington University School of Medicine, St. Louis, MO; and the Division of Pulmonary and Critical Care Medicine (Drs Pastis, Furukawa, and Silvestri), Medical University of South Carolina, Charleston, SC.

CORRESPONDENCE TO: Alexander Chen, MD, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: achen@dom.wustl.edu


FUNDING/SUPPORT: Grant funding was provided by Veran Medical Technologies.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1275-1281. doi:10.1378/chest.14-1425
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BACKGROUND:  Electromagnetic navigation has improved the diagnostic yield of peripheral bronchoscopy for pulmonary nodules. For these procedures, a thin-slice chest CT scan is performed prior to bronchoscopy at full inspiration and is used to create virtual airway reconstructions that are used as a map during bronchoscopy. Movement of the lung occurs with respiratory variation during bronchoscopy, and the location of pulmonary nodules during procedures may differ significantly from their location on the initial planning full-inspiratory chest CT scan. This study was performed to quantify pulmonary nodule movement from full inspiration to end-exhalation during tidal volume breathing in patients undergoing electromagnetic navigation procedures.

METHODS:  A retrospective review of electromagnetic navigation procedures was performed for which two preprocedure CT scans were performed prior to bronchoscopy. One CT scan was performed at full inspiration, and a second CT scan was performed at end-exhalation during tidal volume breathing. Pulmonary lesions were identified on both CT scans, and distances between positions were recorded.

RESULTS:  Eighty-five pulmonary lesions were identified in 46 patients. Average motion of all pulmonary lesions was 17.6 mm. Pulmonary lesions located in the lower lobes moved significantly more than upper lobe nodules. Size and distance from the pleura did not significantly impact movement.

CONCLUSIONS:  Significant movement of pulmonary lesions occurs between full inspiration and end-exhalation during tidal volume breathing. This movement from full inspiration on planning chest CT scan to tidal volume breathing during bronchoscopy may significantly affect the diagnostic yield of electromagnetic navigation bronchoscopy procedures.

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