Comparing Pulmonary Nodule Location During Electromagnetic Bronchoscopy with Predicted Location Based on Two Virtual Airway Maps at Different Phases of Respiration

Background

Electromagnetic navigational bronchoscopy (ENB) is guided-bronchoscopy to pulmonary nodules (PN) which relies on a pre-procedural chest CT to create a 3-dimensional (3-D) virtual airway map. The CT is traditionally done at a full inspiratory breath hold (INSP) but the procedure is performed while the patient tidal breaths, where lung volumes are closer to functional residual capacity. Movement of a PN from INSP to expiration (EXP) has been shown to average 17.6 mm. Therefore, the hypothesis of this study is that pre-procedural virtual maps built off a CT closer to physiological lung volumes during bronchoscopy may better represent the actual 3-D location of a PN.

Methods

Consecutive patients with a PN needing a histological diagnosis were enrolled. A pre-procedure INSP and EXP CT scan were obtained to create two virtual maps. During the airway inspection, the system tracked the sensor probe to collect 3-D points which were reconstructed into the lumen registration map. This map is thought to best represent the patient's airways during bronchoscopy. Predicted PN location on an EXP and INSP map was compared with lumen registration.

Results

Twenty consecutive PN underwent ENB. The predicted PN location, as compared with lumen registration, was significantly closer on EXP vs. INSP (4.5 mm ± 3.3 mm vs. 14.8 mm ± 9.7 mm; p Conclusions

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