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A novel system for electromagnetic navigation in bronchoscopy (ENB) to improve peripheral lesion targeting and diagnostic is currently under development, and preliminary tests on a complex phantom are presented in this paper. The system named Transbite is proving to be easy to use, accurate and useful for experienced and beginner users, with precision around 5-9 mm in reaching targets in sub-segmental bronchi where a conventional video-bronchoscope cannot extent. Transbite system consists of a planning and orientation software, a navigation and biopsy forceps, an active marker that is placed on patient chest and an electromagnetic tracking system from the market connected to a computer containing the software. Transbite can be used with any bronchoscopy system, has a short set-up procedure and learning curve. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact. methods: A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology. Results: Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or nondiagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediastinal LNs in patients with known or suspected lung cancer was 82.35%, 100%, and 90% respectively. The negative predictive value was 80% and the positive predictive value was 100%. There were 20 patients with suspicious mediastinal LNs of uncertain etiology, with a definitive diagnosis being made using EGD/EUS-FNA in 95%. Conclusion: Our data supports the use of EUS-FNA in the work-up of enlarged mediastinal LNs on cross sectional imaging, thus avoiding more invasive mediastinal sampling procedures and potentially futile surgery. [ABSTRACT FROM AUTHOR]

Contrast agents are increasingly being used to characterize the vasculature in an organ of interest, to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures. We review the mechanisms of action of first, second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal tract. Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy, assessment of depth of invasion of esophageal, gastric and gall bladder cancers and visualization of the portal venous system and esophageal varices. In addition, contrast agents can be used to differentiate pancreatic lesions. The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies. The sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast agents. Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion. In the future, these techniques could potentially be used to quantify tumor perfusion, to assess and monitor the efficacy of antiangiogenic agents, to assist targeted drug delivery and allow molecular imaging.