Abstract No. 583 Augmented fluoroscopy-guided endobronchial and transbronchial biopsy using endovascular steerable guiding sheaths in swine

Abstract

To assess the feasibility of interventional radiology (IR) methods to perform bronchoscope-free augmented fluoroscopy (AF)-guided endobronchial biopsy using endovascular steerable guiding sheaths compared to interventional pulmonology (IP) methods with a bronchoscope. All animal procedures were approved by the ACUC. Prototype AF guidance software (Philips) based on cone-beam CT (CBCT) and incorporating airway, targets and navigational pathways was used to guide device placement. CBCT was used to evaluate accuracy of first-pass biopsy needle delivery or to updated planning for a second pass. Ex vivo studies were conducted in a fixed swine lung (Nasco). Biopsy needle delivery accuracy with two endobronchial non-steerable precurved guiding sheaths [Edge 90 and Edge 180 (Superdimension, Medtronic)] and two endovascular steerable guiding sheaths [6.5F Destino Twist (DT) (Oscor Inc.) and the 6F Morph (BioCardia) was compared to bronchoscopy. In the in vivo swine study (n = 4), two steerable guiding sheaths were used to deliver a needle (n = 2 swine, 4 biopsies/sheath) or an embolization coil (n = 2 swine, 3-4 coils/sheath). Endpoints in both studies were first-pass and second-pass biopsy needle delivery error defined by the distance between the needle and target center. Ex vivo, first-pass needle delivery error using the bronchoscope was 10.3 ± 4.0 mm. Errors using the precurved Edge 90 and Edge 180 guiding sheaths were 14.3 ± 8.7 mm and 11.4 ± 8.3 mm, respectively. The needle delivery errors for the steerable Morph and DT guiding sheaths were 8.6 ± 2.9 mm and 11.7 ± 2.6 mm, respectively. Second-pass delivery errors were 8.7 ± 0.9 mm (Edge 90), 5.4 ± 1.9 (Edge 180), 5.6 ± 2.4 mm (Morph) and 4.7 ± 1.2 mm (DT), respectively. In vivo, biopsy needle delivery error was 15 ± 7 mm using the Morph and 6 ± 1 mm using the DT. Embolization coil delivery success was 100% successful for both the Morph and DT. Use of steerable guiding sheaths combined with CBCT-based AF image guidance provided the tools for bronchoscope-free endobronchial-guided biopsy is feasible. IR methods in addition to nondiagnostic IP based bronchoscope-guided endobronchial biopsy.