Diagnosing challenging pulmonary nodules with virtual bronchoscopic navigation and augmented fluoroscopy

Abstract

<b>Background:</b> Lung cancer screening will increase the detection of solitary pulmonary nodules (SPN). Advanced bronchoscopic methods such as virtual bronchoscopy navigation (VBN) with augmented fused fluoroscopy (Archimedes^TM System) may improve the diagnostic yield of small SPN. <b>Objective:</b> To analyse the feasibility of Archimedes^TM interventions for the diagnosis of SPN. <b>Methods:</b> From 01/20 – 01/22 67 patients with SPN were examined with the Archimedes^TM System. Navigation pathways were semi-automatically calculated using pre-interventional CT scan. SPN were targeted via the pathway of VBN with augmented fused fluoroscopy. Interventions were done in general anaesthesia with chest tube. <b>Results:</b> 67 Patients, 49% female, 66 years (±8) were analysed. The SPN-diameter measured 13.9mm (±6.1). Bronchus sign was seen in CT scan in 34%. The distance from the last reconstructed bronchus to the lesion and from the lesion to the pleura was 18.8mm (± 14.7) and 19.5mm (± 15.5) respectively. rEBUS reached the lesion in 61.2%. Time to location was 10min in mean. Tunnelling was performed in 19.4% of the cases. Mild bleeding occurred in 23.9%, pneumothorax requiring chest tube in 4.5%. In total sensitivity was calculated 56.5%, negative predictive value (NPV) 50% and the accuracy 69.7%. Factors increasing the diagnostic yield are identified as distance to the target &lt;20mm in planning and reaching the virtual target in 2 or 3 planes in augmented fluoroscopy. <b>Conclusion:</b> A high diagnostic yield for small peripheral SPN can be achieved with Archimedes^TM&nbsp;interventions. Distance to the target &lt; 20mm has the highest impact on the diagnostic yield.