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• 29664

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  MS16 - The Interventional Pulmonologist's Contribution to Screen-Detected Nodules: From Diagnosis to Treatment (ID 79)

  • Event: WCLC 2019
  • Type: Mini Symposium
  • Track: Interventional Diagnostics/Pulmonology
  • Presentations: 1
  • Now Available
  • Moderators:Luc Thiberville, Kazuhiro Yasufuku
  • Coordinates: 9/10/2019, 14:30 - 16:00, Toronto (1985)

  • 29665

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    MS16.01 - Getting to the Target: Transparenchimal Approaches (Now Available) (ID 3530)

    14:30 - 16:00  |  Presenting Author(s): Daniela Gompelmann
    • Abstract
    • Presentation
    • Slides

    Abstract
    

    The Bronchoscopic Transparenchymal Nodule Access (BTPNA) is a guidance technique that provides to establish tissue diagnosis for peripheral pulmonary nodules. This method differs completely from other guidance techniques as it allows to access nodules via the healthy lung parenchyma and thus is independent on the need to have an airway leading into the lesion [1]. Prior to bronchoscopy, a virtual bronchoscopy navigation system is used that calculates the point of entry (POE) with a straight line, vessel-free access to the lesion and displays the tunnel path from the POE on the airway wall to the target nodule on the basis of the patient´s computed tomography scan. During the endoscopy, the POE is identified under virtual guidance. Then a coring needle is used to penetrate the airway wall and this hole is enlarged by a balloon dilator. Afterwards, a sheath is advanced through the lung parenchyma in order to create a tunnel to the target lesion under fluoroscopic guidance. Once the nodule is achieved, the stylet can be removed and a biopsy forceps is advanced through the sheath in order to sample the lesion. So far, the BTPNA is still investigational and different trials are ongoing to evaluate the diagnostic yield of the BTPNA. Up to date, two prospective trials confirmed the safety and feasibility of the BTPNA in 18 patients with peripheral lesions from suspected lung cancer or metastatic disease [2; 3]. The tunnel path was successfully created in 89% and adequate histological sampling was attained. The only adverse events were pneumothorax in two patients with the need for chest tube insertion in one of them and a transient rise in troponin levels in another patient. In a further prospective trial of BTPNA that was presented on this year´s ATS congress a diagnostic yield of 83.3% was found.

    References:

    [1] Gompelmann D. Upcoming techniques. In: Interventional Pulmonology. Herth, Shah, Gompelmann (eds). ERS monograph 2017.

    [2] Herth FJ, Eberhardt R, Sterman D, Silvestri GA, Hoffmann H, Shah PL. Bronchoscopic transparenchymal nodule access (BTPNA): first in human trial of a novel procedure for sampling solitary pulmonary nodules. Thorax 2015. 70:326-323.

    [3] Harzheim D, Sterman D, Shah PL, Eberhardt R, Herth FJ. Bronchoscopic Transparenchymal Nodule Access: Feasibility and Safety in an Endoscopic Unit. Respiration 2016. 91:302-306.

    [4] Criner G. Bronchoscopic Transparenchymal Access of a Peripheral Pulmonary Nodule. Session D83. ATS 2019.

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