Update on Navigational Bronchoscopy: Electromagnetic Navigation Bronchoscopy
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1 Update on Navigational Bronchoscopy: Electromagnetic Navigation Bronchoscopy and Lung Point The Prince Charles Hospital University of Queensland Thoracic Research Center AUSTRALIA The Prince Charles Hospital University of Queensland Thoracic Research Center AUSTRALIA 1
2 Disclosures TPCH UQ Thoracic Research Centre has undertaken a field evaluation of SuperDimension ENB is evaluating LungPoint Virtual Bronchoscopy is seeking Super PhD students Team includes Steven Leong, Rayleen Bowman, Ian Yang, Henry Marshall, Peter Robinson, Ann Maree Ree, Liz McCaul, Linda Passmore, Deb Courtney, Stan Redmond, Bronchoscopy Nurses CathySaxon et al, and many others our patients and collaborators Lungosity nodule challenge 2
3 Lungosity nodule challenge Lungosity nodule challenge 3
4 Lungosity challenge Nodule diagnostic challenge Navigate Localise 4
5 LungPoint Virtual Bronchoscopy LungPoint Import CT from PACS server, disc or flash drive System reconstructs 3D airways / major vessels from CT scan; Calculates centerline for each airway Find target on CT image and calculate pathways Virtual bronchoscopic simulation of airway view shows generations greater than 3mm Target is superimposed on virtual bronchoscopic view Distance & airway diameter measurements provided, enabling localization of target 320_lungpoint_marketing_brochure_0313.pdf 5
6 LungPoint 320_lungpoint_marketing_brochure_0313.pdf Eberhardt et al; JTO
7 Eberhardt et al; JTO 2010 Lung Point + Ultrafine example 7
8 Virtual Bronchoscopy Study McAdams et al (1998) Lacasse et al (2004) Asano et al (2006) Tachihara et al (2007) Eberhardt et al (2010) Iwano et al (2011) Ishida et al (2011) Tamiya et al (2013) Asano et al (2013) Prospective Lesion Average Yield (%) Complic P (N) size (cm) % P P 136 N/A Endobr: Sens 68%,Spec 90% Lobar: Sens 76%, Spec 48% P P (overall) : standard; 56.9: ultrathin P Retro 122 N/A P RCT VBNA 80.8; NVBNA P P RCT VBN group: 67.1; Non-VBN: Endobronchial Ultrasound and Novel Navigation Biopsy Techniques Chenna, Chen 2014 Electromagnetic Navigation Bronchoscopy 8
9 Electromagnetic Navigation Bronchoscopy CT-Scan DICOM CD Planning Software Planned Pathway File Navigation Biopsy Treatment Bronchoscopic Access: LG and EWC go through mouth/nose to steer through bronchial tree Planning Screen Locatable Guide (LG): 360 steerability for navigation to lesions and lymph nodes Patient Sensor Triplets: Placed on patient and are tracking sensors to show LG position and account for patient movement Location Board Extended Working Channel (EWC): Lock EWC in place for insertion of biopsy tools and other catheters 9
10 10
11 Equipment TPCH Learning Curve (n=30) 100% Diagnosis achieved with ENB (divided into tertiles) 90% 80% 70% 60% 50% 40% No Yes 30% 20% 10% 0% 0 to to to 30 Procedure Number 11
12 Examples ENB studies: lesion size Average size (cm) Odronic et al (2014) Loo et al (2014) Balbo et al (2013) Karnak et ala (2013) Jensen et al (2012) Brownback et al (2012) Lamprecht et al (2012) Pearlstein et al (2012) Mahajan et al (2011) Seijo (2010) Eberhardt et al (2010) Lamprecht et al (2009) Tachihara et al (2007) Eberhardt et al (2007) Eberhardt et al (2007) Makris et al (2007) Gildea et ala (2006) Schwartz et al (2006) Becker et al (2005) Average size (cm)
13 ENB studies: yield /complications Odronic et al (2014) Loo et al (2014) Balbo et al (2013) Karnak et ala (2013) Jensen et al (2012) Brownback et al (2012) Lamprecht et al (2012) Pearlstein et al (2012) Mahajan et al (2011) Seijo (2010) Eberhardt et al (2010) Lamprecht et al (2009) Tachihara et al (2007) Eberhardt et al (2007) Eberhardt et al (2007) Makris et al (2007) Gildea et ala (2006) Schwartz et al (2006) Becker et al (2005) Complications (%) Yield (%) EBUS + ENB Increases Yield Multimodality RCT 120 patients randomised ENB EBUS ENB+EBUS Mean size (mm) 28±8 (13 58) 25±5 (17 35) 24±5 (14 32) Yield 59% 69% 88% (p=0.02) Attempts to navigate, Procedure time not reported Eberhardt et al. AJRCCM 2007; 176 :
14 Next Gen Catheters Edge superdimension X Pre formed curved tip X Telescope steering Control 14
15 Therapeutic Applications J Thorac Oncol Feb;10(2): Multimodality guidance for accurate bronchoscopic insertion of fiducial markers. Steinfort DP1, Siva S, Kron T, Chee RR, Ruben JD, Ball DL, Irving LB. Meta Analysis of Guided Bronchoscopy Guide sheath Ultrathin Wang Memoli, Nietert, Silvestri Chest Oct 6 online
16 Significant movement of pulmonary lesions between full inspiration and end exhalation during tidal volume breathing ave 17.6mm Chen et al 2015 Chest on line Fig 2. Average Nodule Movement Per Lobe Fig 3. Inspiratory and Expiratory Chest CT full inspiration in grey and on endexhalation from tidal volume in blue 16
17 Lungosity nodule challenge EBUS GS miniprobe TBBx Thank you more at. 17
18 18
19 Study Study design Lesions (N) Average size (cm) Yield (%) Complications (%) Becker et al (2005) Retrospective Schwartz et al (2006) Prospective Gildea et ala (2006) Prospective Makris et al (2007) Prospective Eberhardt et al (2007) Prospective Eberhardt et al (2007) Prospective Tachihara et al (2007) Prospective Lamprecht et al (2009) Retrospective Eberhardt et al (2010) Prospective Seijo (2010) Prospective Mahajan et al (2011) Retrospective Pearlstein et al (2012) Retrospective Lamprecht et al (2012) Prospective Brownback et al (2012) Retrospective Jensen et al (2012) Retrospective Karnak et ala (2013) Prospective Balbo et al (2013) Prospective 41 N/A 70.7 N/A Loo et al (2014) Retrospective Odronic et al (2014) Retrospective Endobronchial Ultrasound and Novel Navigation Biopsy Techniques Chenna, Chen
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