RT Journal Article
SR Electronic
T1 Trans-parenchymal nodule access (TPNA) - Real-time image-guided approach to pulmonary nodules
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1387
VO 40
IS Suppl 56
A1 Felix J.F. Herth
A1 Gerard A. Silvestri
A1 Thomas Keast
A1 Lav Rav
A1 Jason Gibbs
A1 Henky Wibowo
A1 Kun-Chang Yu
A1 Daniel H. Sterman
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/1387.abstract
AB BACKGROUND: Currently, pulmonary nodules (PN) are accessed by Transthoracic Needle Aspiration (TTNA) or Transbronchial Needle Aspiration (TBNA). There is a clinical need for improvement of bronchoscopic access to small (<10mm) intraparenchymal PNs such that the high yield of TTNA and the safety of TBNA is achieved.OBJECTIVE: To assess the safety and yield of Trans-Parenchymal Nodule Access (TPNA).METHODS: In a healthy canine model, multiple 0.25cc calcium hydroxylapatite injections were implanted to represent ≤8mm diameter PNs in the upper and lower lobes. CT scans were acquired and plans were generated to prescribe a vessel-free, straight-line path from a central airway location directly to the target using an image guidance system (LungPoint®). Access through the airway wall was initiated with a TBNA needle followed by balloon dilation and sheath insertion. Advancement of the sheath was guided by overlaying CT-defined targets and tunnels onto the live fluoroscopy images using the system. The sheath enabled target sampling with 2.0mm biopsy forceps through the lumen.RESULTS: In 10 canines, 31 targets averaging 34mm (21mm – 50mm) from the airway wall and 7.6mm (0.1mm – 21mm) from the pleura, were accessed via TPNA and sampled. Sampling results indicated a yield of 90.4% with no pneumothoraces and minimal bleeding (<2ml).CONCLUSIONS: These canine studies demonstrate that TPNA has the potential to achieve the high yield of TTNA with the low complication profile associated with TBNA.