Intraprocedural real-time imaging and tissue sampling in peripheral bronchoscopy

Area of Science:

• Pulmonology
• Medical Imaging
• Interventional Pulmonology

Background:

• Peripheral lung lesions present diagnostic challenges.
• Computed tomography (CT)-guided transthoracic needle aspiration is the standard for tissue diagnosis.
• Navigational bronchoscopy is increasingly used but faces challenges in diagnostic yield.

Purpose of the Study:

• To review advances in navigational bronchoscopy for peripheral lung lesions.
• To highlight techniques improving diagnostic yield.
• To emphasize the role of intraprocedural imaging.

Main Methods:

• Integration of advanced intraprocedural imaging: cone beam CT, digital tomosynthesis, augmented fluoroscopy.
• Techniques to identify and correct CT-to-body divergence.
• Methods to confirm biopsy tool placement within the lesion.

Main Results:

• Advanced imaging improves diagnostic accuracy in peripheral bronchoscopy.
• Real-time imaging compensates for lesion movement and navigational errors.
• Accurate tool-in-lesion confirmation enhances biopsy success.

Conclusions:

• Real-time imaging is crucial for increasing diagnostic accuracy in peripheral bronchoscopy.
• Identifying and correcting CT-to-body divergence is vital.
• Technological advancements enhance the ability to sample peripheral lung lesions effectively.