RT Journal Article
SR Electronic
T1 Bronchoscopic trans-parenchymal nodule access (BTPNA) – A new real-time image-guided approach to accessing solitary pulmonary nodules (SPNs) - First in human data
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P692
VO 44
IS Suppl 58
A1 Felix J.F. Herth
A1 Daniela Gompelmann
A1 Hans Hoffmann
A1 Dan Sterman
A1 Gerard Silvestri
A1 Pallav Shah
A1 Ralf Eberhardt
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P692.abstract
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.