ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Application of Ion Robotic Virtual Bronchoscopic Navigation with Cone Beam Computed Tomography in Biopsying Suspicious Pulmonary Nodules
Session Title
TP137 - TP137 THORACIC ONCOLOGY: DIAGNOSIS AND TREATMENT: IP, SURGERY, AND RADIATION
Abstract
A4819 - Application of Ion Robotic Virtual Bronchoscopic Navigation with Cone Beam Computed Tomography in Biopsying Suspicious Pulmonary Nodules
Author Block: S. Verga, R. M. Marron, N. Kaur, J. Thomas, G. J. Criner; Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, United States.
Rationale: There has been vast improvement in diagnostic bronchoscopy with development of virtual and electromagnetic navigational platforms (e.g. Archimedes, SuperDimension, Veran) however based on multiple clinical trials the average diagnostic yield is ~ 80% compared to computed tomography (CT) guided transthoracic needle aspiration (TTNA) which can exceed 90%. This however comes with the increase risk of pneumothorax. Currently there are 2 robotic navigational platforms, Ion by Intuitive and Monarch by Auris; both systems potentially allow for improvement in diagnostic yield particularly in peripheral and sub-solid lesions. We reviewed the application of Ion robotic platform at a large inner-city hospital. Methods: Prospective data collection of the first 40 cases performed using the Ion robotic virtual navigational platform at large tertiary hospital from January to October 2020. Cone beam CT (CBCT) spin performed to assist with virtual nodule placement on real-time fluoroscopy. Biopsy yield was determined based on adequate tissue sampling and compared to suspicious pulmonary nodules (SPN) factors: lesion size, distance to pleura, lobe location, generation of airway and visibility on radial endobronchial ultrasound (REBUS) and/or fluoroscopy. Monitored for any adverse events. Data is presented as mean ±SD.Results: Forty patients with 57 nodules underwent Ion robotic virtual navigational bronchoscopy (VBN) with CBCT. Mean age was 67±9 years and 57% were female. SPN characteristics: mean length of procedure 78 ±20 minutes, visible on fluoroscopy 61% versus 96% on REBUS, 81% of nodules less than 20mm, distance from pleura 19±13mm and majority of SPNs (42%) located in right upper lobe. Nodule distribution based on airway generation: majority located in 7th generation (54%) followed by 6th generation at 24%. Techniques used for specimen obtainment included transbronchial biopsy (18%), brushing (53%), needle aspiration (61%), and bronchoalveolar lavage (20%). Biopsy yield defined as adequate tissue sampled was overall 80%; one-year follow-up is pending to determine diagnostic yield. Major complications: two (5%) pneumothorax, two major bleeding events, two respiratory failure with one individual requiring intensive care admission and one procedure aborted for dynamic hyperinflation of native lung in lung transplant recipient.Conclusion: The incorporation of robotic VBN with CBCT has similar biopsy yield compared to prior clinical trials utilizing other navigational platforms however majority of nodules in our data collection were less than 20mm and in the periphery. The potential application of robotic VBN in therapeutic ablation management of SPNs is currently being investigated.
Author Block: S. Verga, R. M. Marron, N. Kaur, J. Thomas, G. J. Criner; Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Philadelphia, PA, United States.
Rationale: There has been vast improvement in diagnostic bronchoscopy with development of virtual and electromagnetic navigational platforms (e.g. Archimedes, SuperDimension, Veran) however based on multiple clinical trials the average diagnostic yield is ~ 80% compared to computed tomography (CT) guided transthoracic needle aspiration (TTNA) which can exceed 90%. This however comes with the increase risk of pneumothorax. Currently there are 2 robotic navigational platforms, Ion by Intuitive and Monarch by Auris; both systems potentially allow for improvement in diagnostic yield particularly in peripheral and sub-solid lesions. We reviewed the application of Ion robotic platform at a large inner-city hospital. Methods: Prospective data collection of the first 40 cases performed using the Ion robotic virtual navigational platform at large tertiary hospital from January to October 2020. Cone beam CT (CBCT) spin performed to assist with virtual nodule placement on real-time fluoroscopy. Biopsy yield was determined based on adequate tissue sampling and compared to suspicious pulmonary nodules (SPN) factors: lesion size, distance to pleura, lobe location, generation of airway and visibility on radial endobronchial ultrasound (REBUS) and/or fluoroscopy. Monitored for any adverse events. Data is presented as mean ±SD.Results: Forty patients with 57 nodules underwent Ion robotic virtual navigational bronchoscopy (VBN) with CBCT. Mean age was 67±9 years and 57% were female. SPN characteristics: mean length of procedure 78 ±20 minutes, visible on fluoroscopy 61% versus 96% on REBUS, 81% of nodules less than 20mm, distance from pleura 19±13mm and majority of SPNs (42%) located in right upper lobe. Nodule distribution based on airway generation: majority located in 7th generation (54%) followed by 6th generation at 24%. Techniques used for specimen obtainment included transbronchial biopsy (18%), brushing (53%), needle aspiration (61%), and bronchoalveolar lavage (20%). Biopsy yield defined as adequate tissue sampled was overall 80%; one-year follow-up is pending to determine diagnostic yield. Major complications: two (5%) pneumothorax, two major bleeding events, two respiratory failure with one individual requiring intensive care admission and one procedure aborted for dynamic hyperinflation of native lung in lung transplant recipient.Conclusion: The incorporation of robotic VBN with CBCT has similar biopsy yield compared to prior clinical trials utilizing other navigational platforms however majority of nodules in our data collection were less than 20mm and in the periphery. The potential application of robotic VBN in therapeutic ablation management of SPNs is currently being investigated.
