Direct Intranodal Visualization During EBUS-TBNA Using the Iriscope: A Novel Case Series

Area of Science:

• Interventional Pulmonology
• Diagnostic Endoscopy
• Mediastinal Pathology

Background:

• Endobronchial ultrasound (EBUS)-guided biopsy is the standard for diagnosing mediastinal diseases.
• Current EBUS techniques lack the ability to visualize intranodal architecture.
• Miniature video probes offer potential for enhanced EBUS diagnostics.

Purpose of the Study:

• To demonstrate the clinical utility of the Iriscope, a miniature videoprobe, for direct visualization of mediastinal lymph node architecture during EBUS-guided biopsy.
• To assess the feasibility and safety of integrating direct intranodal endoscopy into interventional pulmonology procedures.

Main Methods:

• A case series of four patients undergoing EBUS-guided biopsy for mediastinal pathologies.
• The Iriscope was inserted through the biopsy tract into lymph nodes under ultrasound guidance after transbronchial needle aspiration.
• Real-time video imaging was used to inspect nodal architecture and tissue consistency.

Main Results:

• The Iriscope successfully provided real-time visualization of intranodal architecture in all four cases.
• The procedure was well-tolerated, technically successful, and complication-free.
• Direct intranodal endoscopy allowed for inspection of nodal consistency, adding a new dimension to diagnosis.

Conclusions:

• Direct intranodal endoscopy using miniature video probes like the Iriscope is feasible and safe.
• This technique enhances the diagnostic capabilities of EBUS-guided biopsy by enabling visualization of lymph node structure.
• Further clinical validation is warranted to integrate this approach into routine interventional pulmonology practice.