Lung Navigation Ventilation Protocol to Optimize Biopsy of Peripheral Lung Lesions

Area of Science:

• Pulmonology
• Interventional Radiology
• Medical Imaging

Background:

• Computed tomography (CT)-to-body divergence poses challenges for peripheral lung biopsies.
• Respiratory motion and atelectasis are key factors contributing to this divergence.

Purpose of the Study:

• To compare a conventional ventilation strategy with a novel lung navigation ventilation protocol (LNVP).
• To evaluate the impact of LNVP on intraprocedural 3D image acquisition and bronchoscopic biopsy of peripheral lung nodules.

Main Methods:

• Retrospective, single-center study of patients with peripheral lung lesions (<30 mm).
• Assessment of atelectasis and tool-in-lesion confirmation using cone beam CT.
• Evaluation of diagnostic yield and complications within 7 days.

Main Results:

• LNVP group showed significantly less dependent and sublobar/lobar atelectasis compared to the conventional group.
• Target lesions were less frequently obscured by atelectasis in the LNVP group.
• Diagnostic yield was higher in the LNVP group (92%) versus conventional (70%), though not statistically significant (P=0.08).

Conclusions:

• LNVP effectively reduces atelectasis and improves lesion visibility during peripheral lung nodule biopsies.
• Further prospective studies are needed to confirm the benefits of protocolized ventilation strategies.