PT  - JOURNAL ARTICLE
AU  - Felix J.F. Herth
AU  - Daniela Gompelmann
AU  - Hans Hoffmann
AU  - Dan Sterman
AU  - Gerard Silvestri
AU  - Pallav Shah
AU  - Ralf Eberhardt
TI  - Bronchoscopic trans-parenchymal nodule access (BTPNA) – A new real-time image-guided approach to accessing solitary pulmonary nodules (SPNs) - First in human data
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P692
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P692.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P692.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Background: There is a need for improving the bronchoscopic yield in accessing small SPNs, especially in the age of screening.PURPOSE: BTPNA is a new imaging guided technique. After calculating a straight line path from an airway wall entry point (POE) to the lesion, an access sheath is fluoroscopically guided through the lung tissue to the lesion. The safety and yield in the first human trial will be presented.METHODS: In patients highly suspicious for NSCLC, BTPNA was performed before surgery. Based on HR-CT scan, modified LungPoint software calculated and displayed a POE and prescribed a straight-line path through parenchymal tissue to the lesion. With the scope appropriately positioned, a needle pierces the POE. A balloon catheter enlarges the opening and a sheath is advanced through it. The sheath and a 15 gauge stylet are advanced to the target lesion under fused CT/fluoroscopic guidance. Once the lesion is reached biopsies are taken.RESULTS: In 12 humans, 10 total tunnels have been created, ranging from 10 to 90 mm in length (mean 4.7 mm). The mean lesion size was 2.6 cm (R 1.7-4.0 cm). The yield was 83% (10 out of 12). The two undiagnosed lesions were both in the apices and not reachable due to an angulation limitation by the scope. There were no pneumothoraces or clinically significant bleeding in the humans. The mean procedure time was 22 min. (R 12-40 min). All surgical procedures were performed without any limitations.CONCLUSIONS: In the first in human trial, it was shown that BTPNA could be performed without any complications and a high success rate. These results must be repeated in larger trials.