Abstract
Transbronchial needle aspiration (TBNA) is a procedure routinely performed to diagnose peripheral pulmonary lesions. However, TBNA is associated with a low diagnostic yield due to inappropriate needle placement. We have developed a flexible transbronchial optical frequency domain imaging (TB-OFDI) catheter that functions as a “smart needle” to confirm the needle placement within the target lesion prior to biopsy. The TB-OFDI smart needle consists of a flexible and removable OFDI catheter (430 µm dia.) that operates within a standard 21-gauge TBNA needle. The OFDI imaging core is based on an angle polished ball lens design with a working distance of 160 µm from the catheter sheath and a spot size of 25 µm. To demonstrate the potential of the TB-OFDI smart needle for transbronchial imaging, an inflated excised swine lung was imaged through a standard bronchoscope. Cross-sectional and longitudinal OFDI results reveal the detailed network of alveoli in the lung parenchyma suggesting that the TB-OFDI smart needle may be a useful tool for guiding biopsy acquisition to increase the diagnostic yield.
Highlights
Lung cancer is the leading cause of cancer related death [1,2,3]
Transbronchial needle aspiration (TBNA) is associated with a low diagnostic yield due to inappropriate needle placement
We have developed a flexible transbronchial optical frequency domain imaging (TB-OFDI) catheter that functions as a “smart needle” to confirm the needle placement within the target lesion prior to biopsy
Summary
It is well established that early detection and diagnosis greatly increases patient survival [4] Macroscopic imaging techniques such as computed tomography (CT) are highly sensitive at detecting small, ≤ 2cm, peripheral pulmonary lesions (PPLs) in the lung but they lack the specificity necessary for diagnosis. Diagnosis of malignancy must be made by excisional biopsy, which may be accomplished by high-risk surgical approaches, percutaneous biopsy, or with low-risk approaches such as bronchoscopy with transbronchial needle aspiration (TBNA). Both endobronchial ultrasound (EBUS) guided and unguided TBNA are associated with unacceptably low diagnostic yields for small lesions and higher-risk procedures are often preferentially performed [4]. We anticipate that a smart TBNA needle that provides confirmation of the needle placement within the lesion of interest prior to biopsy will result in an increase in the diagnostic yield
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