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Bronchoscopy-guided and image-guided lung biopsies each play a key role in the pathologic diagnosis of malignancies in the lung. Merging these technologies combines the central accessibility and lower complication rate of bronchoscopic biopsies with the precision and reach of image-guided biopsies. The purpose of this study is to describe our experience using a combination of cone-beam CT (CBCT), 3D coregistration and fluoroscopic overlay tools, and electromagnetic navigational bronchoscopy (EMNB) to guide transbronchial lung biopsies. A retrospective review was performed of transbronchial lung biopsies utilizing fluoroscopic image guidance at a single institution. The target lesion was identified on pre-procedure CT and coregistration was performed using either CBCT or osseous landmarks on multiple fluoroscopic views, enabling the target lesion to be overlaid on live fluoroscopy (AW Volume Viewer, GE Healthcare, Chicago, IL). EMNB was used to navigate a bronchoscope to the nearest bronchus to the lesion (Medtronic, Minneapolis, MN). Live fluoroscopy with lesion overlay was used to guide needle passes from the bronchoscope into the lesion. Technical success and outcomes were reviewed. Six lung lesions with a mean diameter of 1.5 cm were biopsied, with an average of 6.8 FNA samples per lesion. Mean patient age was 61 years old. Mean procedure length was 60.2 minutes. Sample adequacy was assessed by an on-site cytologic technologist in 3 cases, all yielding adequate samples. Biopsies were diagnostic in 4 cases. In the 2 nondiagnostic biopsies, subsequent percutaneous biopsies were diagnostic. There were no immediate complications. The technique described was a safe and efficient method for bronchoscopic biopsy in our initial experience. The use of advanced segmentation and overlay tools enable live fluoroscopic visualization of respiratory motion and guidance for transbronchial needle passes, eliminating the time and radiation associated with post-pass CBCT to confirm intralesional position. Intraprocedural assessment of sample adequacy reduces the rate of non-diagnostic biopsy.
Datta et al. (Wed,) studied this question.