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Electromagnetic navigational bronchoscopy (ENB), one of the methods of navigational bronchoscopy is an advanced diagnostic tool allowing tissue sampling at the lung peripheries which were previously accessible only by computed tomography (CT) guidance or video-assisted thoracoscopic surgery (VATS). We report a 53-year-old man who presented with a c...
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Context 1
... bronchoscopy was performed initially under conscious sedation (fentanyl and midazolam) which did not reveal any endobronchial lesion. Transbronchial lung biopsy under the guidance of Veran ENB was performed via bronchoscopy with working channel 2.8 ( Figure 2). Biopsies were taken from the medial segment of the right middle lobe (RB5) and anterior segment of left lower lobe (LB7). ...
Context 2
... and expiratory CT images were then transferred to a software to construct a virtual airway leading to these peripheral lesions. In view of the presence of an airway leading to the lesion, the patient was subjected to ENB. Flexible bronchoscopy was performed initially under conscious sedation (fentanyl and midazolam) which did not reveal any endobronchial lesion. Transbronchial lung biopsy under the guidance of Veran ENB was performed via bronchoscopy with working channel 2.8 ( Figure 2). Biopsies were taken from the medial segment of the right middle lobe (RB5) and anterior segment of left lower lobe (LB7). There were no complications post procedure. Both biopsies revealed small cell carcinoma with immunohistochemical studies positive for TTF-1 and CD56. A final diagnosis of extensive stage small cell lung cancer was ...
Citations
... A needle biopsy is then advanced until it reaches the targeted lesion. 2 To date, two different commercially available systems exist that uses ENB: (a) the SpiNDrive (Veran Medical Technologies, Inc., St. Louis, MO) that is able to 'track' instruments and thus improves the accuracy, and (b) superDimension ENB (Medtronic, Minneapolis, MN) which is widely used. ...
Here, we describe the case of a 67-year-old man who had been under surveillance for solitary pulmonary nodule for two years and was diagnosed with malignancy via electro-navigational bronchoscopy (ENB). Surveillance computed tomography scan of the thorax showed annual growth increments of the pulmonary nodule. In view of his Brock score showing a 35% probability of malignancy, the patient was subjected to ENB, and metastatic adenocarcinoma from the gastrointestinal tract was diagnosed. ENB was done using a machine on loan from Veran Medical Technologies. The procedure was successful, with no immediate or long-term complications. The diagnosis following histopathological examination was adenocarcinoma, and he was subsequently referred to our oncology unit for further management.
Guided bronchoscopy offers a minimally invasive and safe method for accessing indeterminate pulmonary nodules. However, all current guided bronchoscopy systems rely on a preprocedural computed tomography (CT) scan to create a virtual map of the patient’s airways. Changes in lung anatomy between the preprocedural CT scan and the bronchoscopy procedure can lead to a divergence between the expected and actual location of the target lesion. Termed “CT-to-body divergence”, this effect reduces diagnostic yield, adds time to the procedure, and can be challenging for the operator. The objective of this paper is to describe the concept of CT-to-body divergence, its contributing factors, and methods and technologies that might minimize its deleterious effects on diagnostic yield.
