SESSION TITLE: EBUS and Image-Guided Bronchoscopy
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Diagnosis of peripheral lung nodules is challenging because they are rarely visualized endobronchially and difficult to biopsy. Although imaging techniques such as endobronchial ultrasound (EBUS) are employed to improve tumor localization, the current EBUS probe provides limited characterization of the lesions and has an outer diameter of 1.4 mm that restricts access to small peripheral airways. Current EBUS probe does not have Doppler mode to identify large blood vessels and thus has the potential of increasing the risk of bleeding with biopsy. We developed a novel co-registered autofluoresence Doppler optical coherence tomography (AF/DOCT) system with a 0.9 mm diameter probe to characterize peripheral lung nodules prior to biopsy in vivo.
METHODS: Patients referred for evaluation of peripheral lung nodules underwent bronchoscopy with examination of standard EBUS and the novel AF/DOCT system. The lesion of interest was first identified with EBUS and then imaged with the AF/DOCT system. The abnormal area was biopsied. AF/DOCT images of pathology proved lung malignancies were reviewed by a panel of a pathologist, respirologists, and AF/DOCT experts.
RESULTS: Fourteen patients with biopsy proven lung cancer underwent examination with AF/DOCT. The majority of the cancers were NSCLC. AF/DOCT images were obtained in all patients and abnormalities such as loss of autofluorescence signals (10/14), epithelial thickening (12/14), tumor invasion through the basement membrane (6/14), alveolar wall thickening or alveolar collapsing (8/14), and lack of back reflections from the normal lung parenchymal structures (7/14) were observed. Large blood vessels were successfully detected and traced in 4 cases.
CONCLUSIONS: In this pilot study, AF/DOCT obtained high quality images of peripheral pulmonary nodules. The present study supports the safety and feasibility of AF/DOCT for the evaluation of lung cancer. The addition of Doppler information may improve biopsy site selection and reduce hemorrhage.
CLINICAL IMPLICATIONS: The novel AF/DOCT system may improve the diagnostic yield of peripheral lung cancers and avoid potential risks of biopsy.
DISCLOSURE: The following authors have nothing to disclose: Wei Zhang, Alexander Ritchie, Hamid Pahlevaninezhad, Anthony Lee, Geoffrey Hohert, Lucas Cahill, Tawimas Shaipanich, Diana Ionescu, Calum MacAulay, Pierre Lane, Stephen Lam
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