SESSION TITLE: Interventional Pulmonology Posters I
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) allows for sampling of mediastinal lymph nodes (LN) and pulmonary lesions for diagnosis and staging of lung cancer. Due to the external diameter, rigid part and angulation of the currently available convex probe EBUS (CP-EBUS), there is limited access to certain N1 nodes and intrapulmonary lesions surrounding segmental bronchi. This has clinical implications for accuracy of staging and appropriate patient selection for various stage-dependent non-surgical and surgical therapies. The aim of this study was to compare accessibility and TBNA capability of the prototype thin convex probe (TCP)-EBUS against CP-EBUS in human ex-vivo lungs rejected for transplant.
METHODS: The prototype TCP-EBUS (BF-Y0055, OLYMPUS MEDICAL SYSTEMS CORP., Tokyo, Japan) with a thinner tip (5.9 mm), greater upward angle (170 degrees), and decreased forward oblique direction of view (20 degrees) was compared to the current CP-EBUS (6.9 mm tip, 120 degrees, and 35 degrees respectively). Accessibility and TBNA capability of the TCP-EBUS and CP-EBUS was assessed equally in ex-vivo human lungs that were declined for lung transplant and accepted with consent for research. To evaluate accessibility to distal airways, the distance of the maximum reach and sustainable endoscopic limit were measured from a fixed standard anatomical point. Bronchoscopy was performed with fluoroscopic assistance. TBNA capability was assessed using the prototype 25G aspiration needle on segmental LNs.
RESULTS: In all evaluated lungs (n=5), the TCP-EBUS demonstrated greater reach and a higher success rate when assessing proximal and distal airways due to its smaller diameter and greater bending angle. The TCP-EBUS averaged 22.1 mm greater maximum reach and 10.3mm further endoscopic visibility range than CP-EBUS, and could assess selectively almost all segmental bronchi (98% right, 91% left) demonstrating nearly twice the accessibility to segmental airways than the CP-EBUS (48% right, 47% left). The prototype successfully biopsied LNs as far as station 13 with adequate sampling quality using the 25G aspiration needle.
CONCLUSIONS: The TCP-EBUS has greater accessibility to peripheral airways in human lungs compared to the CP-EBUS and is capable of sampling segmental LNs using the aspiration needle.
CLINICAL IMPLICATIONS: The TCP-EBUS will allow for more precise assessment of N1 nodes when staging cancer and possibly intrapulmonary lesions normally inaccessible to the conventional CP-EBUS.
DISCLOSURE: Kazuhiro Yasufuku: Grant monies (from industry related sources): Grant from OLYMPUS MEDICAL SYSTEMS CORP. for continuing medical education and research The prototype thin convex probe endobronchial ultrasound was provided by OLYMPUS MEDICAL SYSTEMS CORP. The following authors have nothing to disclose: Priya Patel, Hironobu Wada, Tatsuya Kato, Kentaro Hirohashi, Spencer Hu, Jin Young Ahn, Daiyoon Lee
Thin Convex Probe-EBUS (BF-Y0055, OLYMPUS MEDICAL SYSTEMS CORP.) was used for the purpose of this experiment. This product is not yet available on the market for human use and is not yet approved for any purpose