Abstract: Biopsy through lung parenchymal lesion using virtual bronchoscopy navigation (VBN) Archimedes with EBUS sheath tunneling

Abstract

Introduction: The (VBN) device (Archimedes, Broncus Medical Inc.) integrates CT pattern recognition software and fluoroscopy providing realtime airway parenchymal navigation called Bronchoscopic TransParenchymal Nodule Access (BTPNA). We present a case in which BTPNA was guided by radial EBUS sheath tunneling. Case: An 84YO man presented for evaluation of SPN in the LUL. CT showed 2 LUL nodules (1cm, 0.8cm). VBN was begun with a medium bronchoscope (Olympus BF-190 4.3OD, 2.1ID). The lateral nodule was found through airway path. Biopsies were done with forceps and FNA. None were adequate per ROSE. Using an 18G FleXNeedle®, a tunnel opening was created at the posterior wall of (LB3c). A Radial EBUS and sheath were introduced into the tunnel, and images were used to advance the catheter sheath to the lesion. The lesion and adjacent blood vessel were located. The Radial EBUS was removed, and using fluoroscopy brushing of the lesion via the catheter was performed obtaining adequate samples. Pathology revealed benign reactive bronchial cells and macrophages. Discussion: This is the first case using VBN to create a tunnel using a radial EBUS sheath (2mm diameter) through the lung tissue to biopsy a distal SPN. Herth et al. did the first trial using the technique, however their tunnels were created using 2.6mm diameter sheath via a therapeutic bronchoscope (6.3OD, 2.6ID) after airway dilation using a balloon.