CONE BEAM CT BRONCHOSCOPY: A PARADIGM SHIFT
KRISH BHADRA, MDCOMMON SPIRIT NATIONAL LUNG COUNCIL CO-CHAIR
GO2 LUNG CANCER FOUNDATION SCIENTIFIC
LEADERSHIP BOARD
DISCLOSURES
Boston ScientificMerit MedicalVeracytePhilips Noah Medical
Medtronic ILSSiemensBodyVisionIntuitiveBiodesix
LUNG NODULE BIOPSIES
IT’S DIFFICULT
HARD TO REACH PLACES
THE LUNG MOVES!
SMALL TARGETS
"You jump in the water, and if you don't have goggles or gear, you can't see the quarter — you're just
groping around blindly," said Rickman, director of interventional pulmonology at Vanderbilt University
Medical Center. "Fortunately, there's somebody who's pioneering the way for this type of lung
biopsy, and he happens to be right here in Chattanooga."
Northwestern
Dr. Gillespie
Dr. Argento
Vanderbilt
Dr. Rickman
Dr. Maldonado
Tulane
Dr. Kheir
Ohio State
Dr. Pannu
Stanford
Dr. Bedi
Harvard
Dr. Panchabhai
VISITING PROFESSORSBaylor
Dr. Jiwani
UCSF Fresno
Dr. Hegde
MD Anderson
Banner
Dr. Shah
IMPORTANCE OF REAL-TIME
CONFIRMATION
Limitations of standard fluoroscopy
• 75 consecutive patients (retrospective)
• 93 lesions
• 15 patients with multiple lesions
• 10 patients with bilateral lesions
• Median lesion size: 16.0mm
• Bronchus sign present in only 39% of cases
• 49% of lesions visible on standard fluoroscopy
CONE-BEAM CT WITH AUGMENTED FLUOROSCOPY AND ENB JOURNAL OF BRONCHOLOGY AND INTERVENTIONAL PULMONOLOGY 2018, VOLUME 25, NUMBER 4, 273-281
Pritchett, et al. Journal of bronchology and interventional pulmonology 2018, Volume 25, number 4, 273-281
CONE-BEAM CT WITH AUGMENTED FLUOROSCOPY AND ENB JOURNAL OF BRONCHOLOGY AND INTERVENTIONAL PULMONOLOGY 2018, VOLUME 25, NUMBER 4, 273-281
Diagnostic Accuracy**
All lesions 93.5%
<10mm (n=19) 89.5%%
<20mm (n=65). 90.8%
>20mm (n=27). 100%
Negative Predictive Value
79.3% - 89.7%
Average CBCT scans per case: 1.5
Average effective dose of 2.0 mSv per CBCT scan
**Diagnostic accuracy represents the malignant and benign lesions as well as the indeterminate lesions confirmed as benign with clinical
and radiographic follow-up divided by the total number of lesions biopsied.
NAVIGATE Thin Scope/rEBUS CBCT/AF/ENB
Yield: 73% Yield: 49% Yield: 94%
20mm31mm
16mm
Median Lesion: 20mm Median Lesion: 31mm Median Lesion: 16mm
MEDIAN LESION SIZE VS. YIELD IN VARIOUS STUDIES
ADVANTAGES OF BRONCHOSCOPY OVER CT FNA
Lower morbidity
Lower mortality
Reduced length of stay
Lower risk of pneumothorax
Allows for mediastinal staging
PAIN POINTS: COST AND RADIATION
EFFECTIVE DOSE OF COMMON PROCEDURES
CTA (PE protocol): 15 mSv
Nuclear Cardiac Stress Test: 9.4 – 12.8 mSv
Cardiac EP Study: 15-39 mSv (per hour)
CT Chest Inspiration/Expiration (i.e. for Veran): 9.5 mSv
Diagnostic Heart Cath: 9-14 mSv
Therapeutic Heart Cath: 15 – 25 mSv
RADIATION DOSE DURING CBCT-GUIDED ENB
FOR DIAGNOSIS OF PULMONARY NODULES
Sputum
Cytology
Traditional
Bronchoscopy
EBUS
Navigation
CTFNA
Thoracic
Surgery
VATS Lung Bx
DIAGNOSTIC YIELD
INVA
SIV
EN
ESS
DIAGNOSTIC YIELD AND
INVASIVENESS
CBCT
Bronch
RESEARCH FOR 2020Papers
Virtual or reality: Divergence between preprocedural computed tomography scans and lung
anatomy during guided bronchoscopy
Accepted for Publication to JTD
Electromagnetic Navigation Bronchoscopy with advanced fluoroscopy-based localization and
intraprocedural local registration for the evaluation of peripheral pulmonary
Submitted to JOBIP
Systematic Review and Meta-Analysis on Proteomic Testing
Submitted to Chest
Active Research Trials
BodyVision Phase 1 trial
Pending Research Trials
Lung Vision multicenter trial
Pulmera CBCT Imaging Trial
Lung Navigation Ventilation Protocol
VERITAS: CT Guided FNA versus Navigational Bronchoscopy Non-inferiority Study
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