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A Prospective Randomized Comparative Study of Three Guided Bronchoscopic Approaches for Investigating Pulmonary Nodules

Authors :
Jose Cardenas-Garcia
Daniela Molena
Lonny Yarmus
Fabien Maldonado
Jennifer P. Steltz
Anil Vachani
Diana Yu
Hans J. Lee
Jason Akulian
Alexander Chen
Momen M. Wahidi
Sam L Solomon
Source :
Chest. 157:694-701
Publication Year :
2020
Publisher :
Elsevier BV, 2020.

Abstract

Background The capability of bronchoscopy in the diagnosis of peripheral pulmonary nodules (PPNs) remains limited. Despite decades of effort, evidence suggests that the diagnostic accuracy for electromagnetic navigational bronchoscopy (EMN) and radial endobronchial ultrasound (EBUS) approach only 50%. New developments in robotic bronchoscopy (RB) may offer improvements in the assessment of PPNs. Methods A prospective single-blinded randomized controlled comparative study to assess success in localization and puncture of PPNs, using an ultrathin bronchoscope with radial EBUS (UTB-rEBUS) vs EMN vs RB in a human cadaver model of PPNs Results Sixty procedures were performed to target 20 PPNs over the study period. Implanted PPNs were distributed across all lobes, with 80% located within the lung periphery. The target PPN mean diameter was 16.5 ± 1.5 mm, with 50% noted to have a CT bronchus sign. The rate of successful PPN localization and puncture was superior when using RB, compared with EMN (80% vs 45%; P = .02). Among unsuccessful needle passes, the median needle to target “miss” distance was significantly different when comparing UTB-rEBUS, EMN, and RB (P = .0014). Conclusions In a cadaver model, use of RB significantly increased the ability to localize and successfully puncture small PPNs when compared with existing technologies. This study demonstrates the potential of RB to precisely reach, localize, and puncture small nodules in the periphery of the lung.

Details

ISSN :
00123692
Volume :
157
Database :
OpenAIRE
Journal :
Chest
Accession number :
edsair.doi...........ab2caad8eec058f25658ecd0ae2a5cf5
Full Text :
https://doi.org/10.1016/j.chest.2019.10.016