scholarly journals Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran’s Affairs Hospital

2021 ◽  
Vol 10 (16) ◽  
pp. 3671
Author(s):  
Chigozirim N. Ekeke ◽  
Matthew Vercauteren ◽  
Smiljana Istvaniczdravkovic ◽  
Roy Semaan ◽  
Rajeev Dhupar
Keyword(s):  
Clinical Utility ◽  
Diagnostic Yield ◽  
Lung Nodule ◽  
Pulmonary Nodules ◽  
Subsequent Treatment ◽  
Diagnostic Tools ◽  
Lung Nodules ◽  
Robotic Assisted ◽  
The Right ◽  
Electromagnetic Navigational Bronchoscopy

The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB has been introduced as a method to overcome these shortcomings. We describe our initial experience in evaluating lung nodules with robotic assisted bronchoscopy. We retrospectively reviewed data on the first 25 patients that underwent robotic-assisted bronchoscopy and biopsy. We analyzed success with localization, diagnostic yield, and post procedural morbidity. Diagnostic yield was 96% (24/25) with no periprocedural morbidity. The majority of nodules were malignant or atypical (76%) and were located in the right upper lobe. Diameter ranged between 0.8–6.9 cm (median size 1–2 cm). Seventy-five percent of patients underwent subsequent treatment for cancer based on these results, with 25% having continued surveillance. Robotic assisted bronchoscopy is safe and accurate. Studies with larger numbers will allow better understanding of the diagnostic yield and clinical utility of this approach in comparison to other diagnostic tools for lung nodules.

HIGH DIAGNOSTIC YIELD IN SAMPLING SUB-CENTIMETER PERIPHERAL PULMONARY NODULES WITH ROBOTIC-ASSISTED BRONSCHOSCOPY

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2039
Author(s):  
Renuka Reddy ◽  
Jessica Baek ◽  
Claudia Tejera Quesada ◽  
Gustavo Avila ◽  
Adam Wellikoff
Keyword(s):  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
Robotic Assisted ◽  
High Diagnostic Yield

scholarly journals A Generalized Deep Learning-Based Diagnostic System for Early Diagnosis of Various Types of Pulmonary Nodules

2018 ◽  
Vol 17 ◽  
pp. 153303381879880 ◽  
Author(s):  
Ahmed Shaffie ◽  
Ahmed Soliman ◽  
Luay Fraiwan ◽  
Mohammed Ghazal ◽  
Fatma Taher ◽  
...  
Keyword(s):  
Random Field ◽  
Field Model ◽  
Lung Nodule ◽  
Diagnostic System ◽  
Pulmonary Nodules ◽  
Lung Nodules ◽  
Geometric Features ◽  
Gibbs Random Field ◽  
Random Field Model ◽  
Spatial Inhomogeneities

A novel framework for the classification of lung nodules using computed tomography scans is proposed in this article. To get an accurate diagnosis of the detected lung nodules, the proposed framework integrates the following 2 groups of features: (1) appearance features modeled using the higher order Markov Gibbs random field model that has the ability to describe the spatial inhomogeneities inside the lung nodule and (2) geometric features that describe the shape geometry of the lung nodules. The novelty of this article is to accurately model the appearance of the detected lung nodules using a new developed seventh-order Markov Gibbs random field model that has the ability to model the existing spatial inhomogeneities for both small and large detected lung nodules, in addition to the integration with the extracted geometric features. Finally, a deep autoencoder classifier is fed by the above 2 feature groups to distinguish between the malignant and benign nodules. To evaluate the proposed framework, we used the publicly available data from the Lung Image Database Consortium. We used a total of 727 nodules that were collected from 467 patients. The proposed system demonstrates the promise to be a valuable tool for the detection of lung cancer evidenced by achieving a nodule classification accuracy of 91.20%.

SAVI SCOUT as a Novel Localization and Surgical Navigation System for More Accurate Localization and Resection of Pulmonary Nodules

2019 ◽  
Vol 26 (4) ◽  
pp. 469-472 ◽  
Author(s):  
Katie N. Cornella ◽  
Brian A. Palafox ◽  
Mahmood K. Razavi ◽  
Christopher T. Loh ◽  
Kelly M. Markle ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Pulmonary Nodule ◽  
Surgical Navigation ◽  
Lung Resection ◽  
Lung Nodule ◽  
Lower Lobe ◽  
Pulmonary Nodules ◽  
Ease Of Use ◽  
Accurate Localization ◽  
The Right

Background. Current techniques for localization and resection of lung nodules carry many intraoperative challenges for surgeons. This article proposes a new localization method for diagnosis and treatment of pulmonary nodules, which provides a navigational system for more accurate lung resection. Methods. We report the case of a 77-year-old female with a pulmonary nodule of the right lower lobe. A nonradioactive localization technology, known as SAVI SCOUT (Cianna Medical Inc, Aliso Viejo, CA), was placed by interventional radiology under computed tomography guidance preoperatively. Using the SCOUT Wire-Free Radar Localization System, the pulmonary nodule was robotically localized and resected. SCOUT removal was confirmed using the Trident Specimen Radiology System. The efficacy of this procedure was evaluated in terms of ease of use and procedure time by interventional radiology, surgical resection accuracy, diagnostic accuracy, simplicity, and ease to implement this technology in an existing hospital. Results. The SCOUT system allowed for the first reported case of successful SCOUT placement in lung tissue, targeted the pulmonary nodule intraoperatively, and facilitated accurate lung resection. Conclusions. The SCOUT system shows promising advancements in the ability to eliminate many challenges currently seen with lung nodule localization and resection.

scholarly journals Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: initial multicenter experience using the Ion™ Endoluminal System

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael J. Simoff ◽  
Michael A. Pritchett ◽  
Janani S. Reisenauer ◽  
David E. Ost ◽  
Adnan Majid ◽  
...  
Keyword(s):  
Target Location ◽  
Diagnostic Yield ◽  
Research Question ◽  
Pulmonary Nodules ◽  
Outer Edge ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Clinical Trial Registration ◽  
Robotic Assisted ◽  
Shape Sensing

Abstract Background Traditional bronchoscopy provides limited approach to peripheral nodules. Shape-sensing robotic-assisted bronchoscopy (SSRAB, Ion™ Endoluminal System) is a new tool for minimally invasive peripheral nodule biopsy. We sought to answer the research question: Does SSRAB facilitate sampling of pulmonary nodules during bronchoscopists’ initial experience? Methods The lead-in stage of a multicenter, single-arm, prospective evaluation of the Ion Endoluminal System (PRECIsE) is described. Enrolled subjects ≥ 18 years old had recent computed tomography evidence of one or more solid or semi-solid pulmonary nodules ≥ 1.0 to ≤ 3.5 cm in greatest dimension and in any part of the lung. Subjects were followed at 10- and 30-days post-procedure. This stage provided investigators and staff their first human experience with the SSRAB system; safety and procedure outcomes were analyzed descriptively. Neither diagnostic yield nor sensitivity for malignancy were assessed in this stage. Categorical variables are summarized by percentage; continuous variables are summarized by median/interquartile range (IQR). Results Sixty subjects were enrolled across 6 hospitals; 67 nodules were targeted for biopsy. Median axial, coronal and sagittal diameters were < 18 mm with a largest cardinal diameter of 20.0 mm. Most nodules were extraluminal and distance from the outer edge of the nodule to the pleura or nearest fissure was 4.0 mm (IQR: 0.0, 15.0). Median bronchial generation count to the target location was 7.0 (IQR: 6.0, 8.0). Procedure duration (catheter-in to catheter-out) was 66.5 min (IQR: 50.0, 85.5). Distance from the catheter tip to the closest edge of the virtual nodule was 7.0 mm (IQR: 2.0, 12.0). Biopsy completion was 97.0%. No pneumothorax or airway bleeding of any grade was reported. Conclusions Bronchoscopists leveraged the Ion SSRAB’s functionality to drive the catheter safely in close proximity of the virtual target and to obtain biopsies. This initial, multicenter experience is encouraging, suggesting that SSRAB may play a role in the management of pulmonary nodules. Clinical Trial Registration identifier and date NCT03893539; 28/03/2019.

Lung Nodule Management: An Interventional Pulmonology Perspective

2018 ◽  
Vol 39 (06) ◽  
pp. 661-666
Author(s):  
Jonathan Kurman ◽  
Amit Mahajan ◽  
D. Hogarth ◽  
Udit Chaddha
Keyword(s):  
Diagnostic Yield ◽  
Lung Nodule ◽  
Lung Nodules ◽  
Interventional Pulmonology ◽  
Technical Aspects ◽  
Factors Affecting ◽  
Comprehensive Knowledge

AbstractWith the rising number of screening and incidentally detected lung nodules, there is an increasing need for evaluation in the safest and least invasive manner. The last two decades have seen substantial evolution in bronchoscopic approaches to diagnose these nodules. Innovative bronchoscopic techniques, often used in conjunction with each other, have significantly improved our ability to navigate to almost any part of the lung. A comprehensive knowledge of available technologies and the factors affecting diagnostic yield is essential to decide on the best way to approach a particular scenario. This article provides an overview of the technical aspects, yield, and limitations of these modalities.

High Accuracy of Digital Tomosynthesis-Guided Bronchoscopic Biopsy Confirmed by Intraprocedural Computed Tomography

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
James Katsis ◽  
Lance Roller ◽  
Michael Lester ◽  
Joyce Johnson ◽  
Robert Lentz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Primary Outcome ◽  
Diagnostic Yield ◽  
Lung Nodule ◽  
Digital Tomosynthesis ◽  
Biopsy Needle ◽  
Bronchoscopic Biopsy ◽  
Axial Dimension ◽  
Electromagnetic Navigational Bronchoscopy ◽  
Room Time

<b><i>Background:</i></b> Digital fluoroscopic tomosynthesis-guided electromagnetic navigational bronchoscopy (F-ENB) is a novel adjunct to ENB associated with higher diagnostic yield. The likelihood of F-ENB allowing accurate placement of a biopsy needle within a target remains unclear. <b><i>Objective:</i></b> This study intends to determine the accuracy of F-ENB as confirmed by cone-beam computed tomography (CBCT) scan. <b><i>Methods:</i></b> Patients undergoing CBCT-assisted ENB for lung nodule biopsy were prospectively enrolled. ENB was performed followed by digital tomosynthesis correction. Once optimal F-ENB alignment was achieved, and a needle was advanced into the expected location of the nodule followed by CBCT. The primary outcome was the percentage of “needle-in-lesion” hits, defined as needle tip within the nodule in 3 planes. Secondary outcomes were diagnostic yield, procedure and room time, complications, radiation, and distance between the needle tip and nodule. <b><i>Results:</i></b> Twenty-six patients with a total of 29 nodules were enrolled. Mean nodule size was 13 mm (±4 mm) in maximal axial dimension, 83% (<i>n</i> = 24) were located in the peripheral third of the chest, and 17% (<i>n</i> = 5) had a bronchus sign. F-ENB guidance resulted in needle-in-lesion in 21 of 29 nodules (72%). Mean needle tip-to-nodule distance for nonhits was 1.75 mm (±1.35 mm). There were no complications. <b><i>Conclusion:</i></b> F-ENB resulted in a needle-in-lesion biopsy in greater than 70% of nodules despite features traditionally associated with poor diagnostic yield (size, absence of bronchus sign). Mean distance between needle tip and target for nonhits was less than 2 mm. These data suggest F-ENB alignment is accurate for small peripheral nodules.

scholarly journals Cone beam CT augmented fluoroscopy allows safe and efficient diagnosis of a difficult lung nodule

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roberto Piro ◽  
Matteo Fontana ◽  
Eleonora Casalini ◽  
Sofia Taddei ◽  
Marco Bertolini ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Yield ◽  
Early Stage ◽  
Lung Nodule ◽  
Lung Cancer Screening ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Lung Nodules ◽  
Proper Position ◽  
Screening Programs

Abstract Background Detection of small peripheral lung nodules is constantly increasing with the development of low dose computed tomography lung cancer screening programs. A tissue diagnosis is often required to confirm malignity, with endobronchial biopsies being associated with a lower pneumothorax rate than percutaneous approaches. Endoscopic diagnosis of peripheral small size lung nodules is however often challenging using traditional bronchoscopy and endobronchial ultrasound alone. New virtual bronchoscopic navigation techniques such as electromagnetic navigational bronchoscopy (ENB) have developed to improve peripheral navigation, with diagnostic yield however remaining in the 30–50% range for small lesions. Recent studies have shown the benefits of combining Cone beam computed tomography (CBCT) with ENB to improve diagnostic yield to up to 83%. The use of ENB however remains limited by disposable cost, bronchus sign dependency and inaccuracies due to CT to body divergence. Case presentation This case report highlights the feasibility and usefulness of CBCT-guided bronchoscopy for the sampling of lung nodules difficult to reach through traditional bronchoscopy because of nodule size and peripheral position. Procedure was scheduled in a mobile robotic hybrid operating room with patient under general anaesthesia. CBCT acquisition was performed to localize the target lesion and plan the best path to reach it into bronchial tree. A dedicated software was used to segment the lesion and the bronchial path which 3D outlines were automatically fused in real time on the fluoroscopic images to augment live guidance. Navigation to the lesion was guided with bronchoscopy and augmented fluoroscopy alone. Before the sampling, CBCT imaging was repeated to confirm the proper position of the instrument into the lesion. Four transbronchial needle aspirations (TBNA) were performed and the tissue analysis showed a primary lung adenocarcinoma. Conclusions CBCT and augmented fluoroscopy technique is a safe and effective and has potential to improve early stage peripheral lesions endobronchial diagnostic yield without ENB. Additional studies are warranted to confirm its safety, efficacy and technical benefits, both for diagnosis of oncological and non-oncological disease and for endobronchial treatment of inoperable patients.

scholarly journals Minimally invasive interventions for pulmonary nodules biopsy. Systematic review protocol.

2020 ◽  
Author(s):  
Andre Miotto ◽  
João Aléssio Juliano Perfeito ◽  
Rafael Pacheco Leite ◽  
Carolina de Oliveira Cruz Latorraca ◽  
Rachel Riera
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Randomized Clinical Trials ◽  
Diagnostic Yield ◽  
Lung Nodule ◽  
Pulmonary Nodules ◽  
Percutaneous Biopsy ◽  
Transbronchial Biopsy ◽  
Endobronchial Ultrasound ◽  
Electromagnetic Navigation

Abstract Background Lung cancer is the most common malignancy, causing more than 1.6 million deaths annually worldwide, including approximately 26.500 deaths in Brazil alone in 2015. The diagnosis of pulmonary nodules remains a challenge. Imaging tests are important for diagnostic suspicion and for estimating risk, but biopsy is necessary to confirm malignancy. Minimally invasive methods currently used include tomography-guided percutaneous biopsy (CTGB) and bronchoscopy transbronchial biopsy. The method of choice should have the best accuracy with the lowest possible complication rate. This systematic review was designed to map, critically evaluate and compare the effects (benefits and risks) of all lung nodule biopsy techniques. Methods We will conduct a systematic review accordantly to the Cochrane Handbook for Systematic Reviews of Interventions recommendations. Discussion This study aims to compare the diagnostic yield and the safety of different techniques used for pulmonary nodule biopsies. We will include randomized clinical trials comparing tomography-guided percutaneous biopsy, non-guided transbronchial biopsy, fluoroscopy-guided transbronchial biopsy, transbronchial biopsy guided by endobronchial ultrasound with radial probe and transbronchial biopsy guided by electromagnetic navigation. This study was approved by the research ethics committee of Universidade Federal de São Paulo (UNIFESP) with the number 1344040918. The results of the completed protocol will be presented at any appropriate conference by the authors.Systematic review registration The protocol for this review was prospectively registered in PROSPERO database (C RD42018092367).

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