Lung cancer: CT guided BX-EBUS: How and when?

Area of Science:

• Pulmonary Medicine
• Diagnostic Imaging
• Interventional Pulmonology

Background:

• Histological diagnosis is essential for characterizing lung lesions and assessing treatment response.
• Flexible bronchoscopy has limited success for peripheral pulmonary lesions not visible endoscopically.
• Computed tomography (CT) guided biopsy is a common, safe, and effective technique for peripheral lesion sampling.

Purpose of the Study:

• To highlight the importance of CT-guided biopsies for peripheral pulmonary lesions.
• To discuss factors affecting diagnostic yield and methods to improve accuracy.
• To present CT-guided biopsy as part of a comprehensive approach including potential interventions.

Main Methods:

• Sampling of peripheral pulmonary lesions using CT guidance, often with coaxial needle systems (18G or 20G).
• Integration of novel guidance and navigation tools for enhanced lesion targeting.
• Utilization of PET/CT fusion imaging for intraprocedural guidance.

Main Results:

• CT-guided biopsy is a key procedure for diagnosis and treatment planning of peripheral pulmonary lesions.
• Factors like small lesion size, low 18F-FDG uptake, and basal location can lead to inconclusive histology.
• Intraprocedural PET/CT fusion imaging can increase diagnostic yield.

Conclusions:

• CT-guided biopsy, especially when enhanced with PET/CT fusion imaging, improves diagnostic accuracy for peripheral pulmonary lesions.
• This approach offers a 'one-stop' solution, combining diagnosis with potential interventions like ablation.
• Further integration of advanced navigation tools can optimize lesion targeting and diagnostic success.