CRYOBIOPSY WITH ROBOTIC NAVIGATIONAL BRONCHOSCOPY: IS THIS THE NEXT STEP TO IMPROVING DIAGNOSTIC YIELD FOR PULMONARY NODULES? FOR MY PATIENT, IT DEFINITELY WAS!

Abstract

TYPE: Case Report TOPIC: Lung Cancer INTRODUCTION: The introduction of robotic navigational bronchoscopy has helped to reach out to the lung periphery to safely biopsy nodules while improving diagnostic yield. Tools such as the brush, fine needle and forceps are the standard. However, the 1.1mm cryoprobe with the use of Ion robotic bronchoscopy could change the way we collect samples for diagnosis. CASE PRESENTATION: 64 year old male with significant tobacco abuse history found to have an incidental right upper lobe ground glass nodule measuring 1.5 cm. Upon further workup, it was not PET avid. The decision was made to follow up with a repeat CT chest in 3 months. The repeat CT suggested a slight change in size but remained ground glass. I proceeded with robotic navigational bronchoscopy and biopsy. During the case, standard brush, 21G FNA needle and forceps were used to collect samples. Afterwards, decision was made to proceed with use the 1.1mm cryoprobe with the Ion Robotic bronchoscopy to collect further samples for diagnosis. DISCUSSION: After several cryobiopsy samples were taken, no significant bleeding was noted for. Post procedure CXR did not show any pneumothorax. Final diagnosis was made via cryobiopsy samples of bronchoalveolar carcinoma while the brush, fine needle aspirate and forcep samples did not show any malignancy according to the pathologist. CONCLUSIONS: With the ability of the Ion robotic bronchoscopy to reach the periphery with ease and equipped with a 2.0 outer diameter working channel, the use of cryoprobe and cryobiopsy could change the way we proceed with doing lung biopsies for pulmonary nodules. DISCLOSURE: Medical Consultant for Intuitive Surgical KEYWORD: Interventional Pulmonary, robotic bronchoscopy