Comparing Diagnostic Yield of Electromagnetic Navigational Bronchoscopy Guided With Real Time Cone Beam Computer Tomography With Standard Fluoroscopy Guidance for Peripheral and Central Lung Lesions

Electromagnetic navigation bronchoscopy has been used for more than a decade to access peripheral and central parenchymal lung lesions bronchoscopically. Traditionally standard fluoroscopy using C-arm is used to confirm the location and guide the biopsy instruments under real-time guidance. With availability of Cone Beam CT, fluoroscopic images of much higher quality and resolution can be obtained intra-operatively. It also enables the bronchoscopist to obtain intraoperative CT images and confirm the exact location of the lesion and the Bronchoscopic biopsy catheter or the biopsy instruments.

At my institution, lung nodules/masses requiring ENB have been approached using Medtronic Super-Dimension Version 7 Electromagnetic Navigational Bronchoscopy system. All the procedures are done under fluroscopic guidance using a regular C-Arm. All the lesions are confirmed using peripheral Endobronchial Ultrasound (EBUS). Once the appropriate location is reached, biopsy is obtained using FNA (18G or 21G), Single or Triple needle brush, Transbronchial forceps and Bronchoalveolar lavage.

A pathologist is present on site for all the cases to review the slides and assist in diagnosis. All the cases are done under general anesthesia through endotracheal tube.

Also, all the ENB procedures have been performed by one Interventional Pulmonologist since August 2017.

For the interventional arm, all the aspects will remain the same except that the cases are done in Hybrid OR instead of Endoscopy. All the patients are completely paralyzed intra-operatively. Also, instead of a standard C-Arm providing 2D fluoroscopic guidance, a Philips Azurion 7 C20 FlexMove system with Emboguide, 3D Segmentaion and Overlay tools is being used. This enables the bronchoscopist to obtain a CT scan of the chest and also segment out the lesion(s) of interest and to overlap the 3-D image of the lesion on live fluoroscopy in all 3 dimensions.