The Archimedes navigation system for the diagnosis of peripheral pulmonary nodule. Report on initial experience.

R. Tazi Mezalek*^a (Dr), P. Serra Mitjà^b (Dr), C. Centeno Clemente^b (Dr), C. Fernandez Arias^b (Dr), E. Barrio Herraiz^b (Dr), F. Andreo García^c (Prof), M. Avila Terzi^d (Dr), E. Castella Fernandez^d (Dr), I. Guasch Arriaga^e (Dr), J. Bechini Bernard^e (Dr), J. Abad Capa^b (Prof), A. Rosell Gratacós^f (Prof)

^a Hospital Germans Trias i Pujol - Head of the Interventional Pulmonology Program - Respiratory Medicine, Badalona (barcelona), SPAIN ; ^b Hospital Germans Trias i Pujol - Respiratory Medicine, Badalona (barcelona), SPAIN ; ^c Hospital Germans Trias i Pujol - Head of Bronchospy Unit - Respiratory Medicine, Badalona (barcelona), SPAIN ; ^d Hospital Germans Trias i Pujol - Department of Pathological Anatomy, Badalona (barcelona), SPAIN ; ^e Hospital Germans Trias i Pujol - Department of Radiology, Badalona (barcelona), SPAIN ; ^f Hospital Germans Trias i Pujol - Respiratory Medicine - Director Clínic de l’Àrea del Tòrax, Badalona (barcelona), SPAIN

* rtazi.germanstrias@gencat.cat

Introduction: peripheral lung nodules diagnosis is still a challenge for bronchoscopists. The Archimedes Navigation System (Broncus Medical) offers intraluminal and extraluminal navigation combined with fused fluoroscopy. Aims and objectives: we report our initial experience of transbronchial biopsy (TBB) and transparenchymal needle aspiration (TPNA).No tunnelling was performed. Methods: Patients were enrolled from July 2019 to April 2022. A High-resolution CT scan was performed 1-5 days before. Cytology brush, TBB and TPNA were performed using the C arm verification. Results: Sixteen patients, 12 men (75%), median age 72 yr (53-81) with pulmonary opacities located in the distal third of the lung, median size 23.4 mm (16-31 mm) were included. Bronchus sign was present in 8 patients (50%).Selective bronchial washing was diagnostic in 25%.Brush cytology with cell blocks was performed in all the cases. ROSE of brush cytology was positive in 43.75% of the cases. Cell blocks were profitable in 86% of the positive cases. TBB were performed in 12 patients (75%) with 66% of diagnostic accuracy. Biopsy smears were positive in 89% of the positive cases. TPNA was performed in 7 patients (43.75%), but only one case was conclusive. Global diagnostic yield was 75%: ADK 43%, colorectal cancer metastasis 16%, SCC 25%, high-grade fusocellular carcinoma 8% and poorly differentiated carcinoma 8%.No major complications were registered. Conclusions: the Archimedes Navigation system brings an optimal planning pathway to target peripheral lung nodules. TBB and brush cytology presented a 75% diagnostic yield in this initial series, while TPNA did not render good results. Training is crucial to increase the initial results.

Disclosure of funding source(s): none