The Archimedes navigation system for the diagnosis of peripheral pulmonary nodule. Report on initial experience.
R. Tazi Mezalek*a (Dr), P. Serra Mitjàb (Dr), C. Centeno Clementeb (Dr), C. Fernandez Ariasb (Dr), E. Barrio Herraizb (Dr), F. Andreo Garcíac (Prof), M. Avila Terzid (Dr), E. Castella Fernandezd (Dr), I. Guasch Arriagae (Dr), J. Bechini Bernarde (Dr), J. Abad Capab (Prof), A. Rosell Gratacósf (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
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