Electromagnetic navigation bronchoscopy

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Electromagnetic navigation bronchoscopy
Other namesEMN bronchoscopy
Specialty radiology interventional

Electromagnetic navigation bronchoscopy (ENB) is a medical procedure utilizing electromagnetic technology designed to localize and guide endoscopic tools or catheters through the bronchial pathways of the lung. Using a virtual, three-dimensional (3D) bronchial map from a recently computed tomography (CT) chest scan and disposable catheter set, physicians are able to navigate to a desired location within the lung to biopsy lesions, stage lymph nodes, insert markers to guide radiotherapy or guide brachytherapy catheters. [1] [2]

Contents

Components

The ENB system consists of four essential components:

Overview

Electromagnetic navigation bronchoscopy consists of two primary phases: planning and navigation. In the planning phase previously acquired CT scans are utilized to mark and plan pathways to targets within the lung. In the navigation phase these previously planned targets and pathways are displayed and can be utilized for navigation and access deep within the lung. Upon arriving at the target ENB enables multiple applications all within the same procedure. [3]

Planning Phase

CT scans of the patient’s chest are loaded into proprietary software that reconstructs the patient’s airways in multiple 3D images. The physician utilizes these images to mark target locations and plan pathways to these target locations within the lungs. [1] [3]

Using the planned pathway created in the Planning Phase and real-time guidance, the physician navigates the steerable sensor probe and extended working channel to the desired target location(s). Once at the desired location, the physician locks the extended working channel in place and the steerable sensor probe is removed. The extended working channel provides access to the target lesion for standard bronchoscopic tools or catheters. [1] [3]

History

According to the Aetna Clinical Policy Bulletin on ENB, "In 2004, the FDA cleared for marketing through the 510(k) process the Medtronic superDimension/Bronchus system, also known as the inReach system (superDimension, Ltd, Israel), a minimally invasive image-guidance localization and navigation system that uses electromagnetic guidance for the management of peripheral lung lesions. [1] The system consists of several components: a guide catheter, a steerable navigation catheter, and planning and navigation software and hardware (i.e., computer and monitor). Navigation is facilitated by an electromagnetic tracking system that detects a position sensor incorporated into a flexible catheter advanced through a bronchoscope. Information obtained during bronchoscopy is super-imposed on previously acquired computed tomography (CT) data and 3-dimensional virtual images. The system was designed to solve the clinical problem of reaching small suspected lesions in the peripheral lung airways and mediastinal lymph nodes and is being proposed as an alternative to open surgical biopsy of distant lung lesions and as an alternative to transthoracic implantation of radiosurgical markers." [4]

Field use and prospective studies

Despite the medical advances of detection, diagnosis and treatment methods throughout the past 50 years, lung cancer causes more deaths than any other cancer in both men and women. [5] Currently, lung cancer is the most common form of cancer diagnosed in the United States and a major cause of death, accounting for 14% of all cancers. [6]

The most effective way of stopping cancer comes at diagnosis and treatment in the early stages. Lung cancer diagnosed in the early stages yields an 88% survival rate at ten years versus 16% at five years when found in the later stages, [7] [8] although 88% rate has only been achieved once. [1]

Although 1 in 500 chest X-rays show a peripheral lesion, [9] 65% of traditional bronchoscopes fail to reach these distant lesions. [10] More invasive diagnostic techniques are then necessary, posing a greater potential for complications such as pneumothorax. [11] Patients with poor lung function may not tolerate more invasive procedures, leaving them with "watchful waiting" as their only option.

There are four publications that show that peripheral lung lesions can be diagnosed successfully in 69% to 86% of cases using the Medtronic superDimension system. [3] [12] [13] [14]

According to the American Journal of Respiratory and Critical Care Medicine, a prospective ... study was conducted to determine the ability of electromagnetic navigation bronchoscopy to sample peripheral lung lesions and mediastinal lymph nodes with standard bronchoscopic instruments and demonstrate safety the ENB." The results provided a "yield/procedure [rate at] 74% and 100% for peripheral lesions and lymph nodes, respectively." Additionally, "a diagnosis was obtained in 80.4% of bronchoscopic procedures." The study concluded that ENB "is a safe method for sampling peripheral and mediastinal lesions with high diagnostic yield independent of lesion size and location". [15]

A similar study of 40 patients issued in the European Respiratory Journal resulted in an overall 62.5% diagnostic yield and concluded; "electromagnetic navigation bronchoscopy without additional fluoroscopic guidance is a safe and efficient technique for the diagnosis of peripheral pulmonary nodules. The overall diagnostic yield found in the present study is superior to rates reported in most previous studies performed for small peripheral pulmonary nodules with bronchoscopy". [16]

Virtual bronchoscopy continues to be an active subject for basic engineering research. The Bioelectromagnetics group at University College Cork has developed a novel low-cost tracking system for use in electromagnetic navigation bronchoscopy. [17] The group is also collaborating with the Surgical Planning Laboratory at Harvard Medical School to develop the world's first open-source virtual bronchoscopy module to be implemented in the 3DSlicer environment. [18]

Related Research Articles

<span class="mw-page-title-main">Lung cancer</span> Malignant tumor characterized by uncontrolled cell growth in lung tissue

Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung. Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged airway cells gain the ability to multiply unchecked, causing the growth of a tumor. Without treatment, tumors spread throughout the lung, damaging lung function. Eventually lung tumors metastasize, spreading to other parts of the body.

<span class="mw-page-title-main">Cytopathology</span> A branch of pathology that studies and diagnoses diseases on the cellular level

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in 1928. Cytopathology is generally used on samples of free cells or tissue fragments, in contrast to histopathology, which studies whole tissues. Cytopathology is frequently, less precisely, called "cytology", which means "the study of cells".

<span class="mw-page-title-main">Pulmonology</span> Study of respiratory diseases

Pulmonology, pneumology or pneumonology is a medical specialty that deals with diseases involving the respiratory tract. It is also known as respirology, respiratory medicine, or chest medicine in some countries and areas.

<span class="mw-page-title-main">Lymphadenopathy</span> Disease of lymph nodes

Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

<span class="mw-page-title-main">Miliary tuberculosis</span> Medical condition

Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.

<span class="mw-page-title-main">Chylothorax</span> Medical condition

A chylothorax is an abnormal accumulation of chyle, a type of lipid-rich lymph, in the space surrounding the lung. The lymphatics of the digestive system normally returns lipids absorbed from the small bowel via the thoracic duct, which ascends behind the esophagus to drain into the left brachiocephalic vein. If normal thoracic duct drainage is disrupted, either due to obstruction or rupture, chyle can leak and accumulate within the negative-pressured pleural space. In people on a normal diet, this fluid collection can sometimes be identified by its turbid, milky white appearance, since chyle contains emulsified triglycerides.

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<span class="mw-page-title-main">Endoscopic ultrasound</span>

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<span class="mw-page-title-main">Mediastinal tumors</span> Medical condition

A mediastinal tumor is a tumor in the mediastinum, the cavity that separates the lungs from the rest of the chest. It contains the heart, esophagus, trachea, thymus, and aorta. The most common mediastinal masses are neurogenic tumors, usually found in the posterior mediastinum, followed by thymoma (15–20%) located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum.

<span class="mw-page-title-main">Endobronchial valve</span>

An endobronchial valve(EBV), is a small, one-way valve, which may be implanted in an airway feeding the lung or part of lung. The valve allows air to be breathed out of the section of lung supplied, and prevents air from being breathed in. This leaves the rest of the lung to expand more normally and avoid air-trapping. Endobronchial valves are typically implanted using a flexible delivery catheter advanced through a bronchoscope in minimally invasive bronchoscopic lung volume reduction procedures in the treatment of severe emphysema. The valves are also removable if they are not working properly.

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Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs. The construction of bronchoscopes ranges from rigid metal tubes with attached lighting devices to flexible optical fiber instruments with realtime video equipment.

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<span class="mw-page-title-main">Lung nodule</span> Medical condition

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<span class="mw-page-title-main">Adenocarcinoma of the lung</span> Medical condition

Adenocarcinoma of the lung is the most common type of lung cancer, and like other forms of lung cancer, it is characterized by distinct cellular and molecular features. It is classified as one of several non-small cell lung cancers (NSCLC), to distinguish it from small cell lung cancer which has a different behavior and prognosis. Lung adenocarcinoma is further classified into several subtypes and variants. The signs and symptoms of this specific type of lung cancer are similar to other forms of lung cancer, and patients most commonly complain of persistent cough and shortness of breath.

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<span class="mw-page-title-main">Pulmonary sclerosing pneumocytoma</span> Medical condition

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References

  1. 1 2 3 4 5 Reynisson, Pall J.; Leira, Håkon O.; Hernes, Toril N.; Hofstad, Erlend F.; Scali, Marta; Sorger, Hanne; Amundsen, Tore; Lindseth, Frank; Langø, Thomas (2014). "Navigated Bronchoscopy". Journal of Bronchology & Interventional Pulmonology. 21 (3): 242–264. doi: 10.1097/LBR.0000000000000064 . PMID   24992135. S2CID   31847196.
  2. 1 2 http://ajrccm.atsjournals.org/cgi/reprint/200603-344OCv1.pdf%5B%5D
  3. 1 2 3 4 Becker, Heinrich D.; Herth, Felix; Ernst, Armin; Schwarz, Yehuda (2005). "Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance". Journal of Bronchology. 12: 9–13. doi:10.1097/01.laboratory.0000147032.67754.22.
  4. ↑ "Electromagnetic Navigation-guided Bronchoscopy". aetna.com.
  5. ↑ Jemal, A.; Siegel, R.; Ward, E.; Murray, T.; Xu, J.; Thun, M. J. (2007). "Cancer statistics, 2007". CA: A Cancer Journal for Clinicians. 57 (1): 43–66. doi: 10.3322/canjclin.57.1.43 . PMID   17237035. S2CID   22305510.
  6. ↑ American Cancer Society, 2006
  7. ↑ International Early Lung Cancer Action Program Investigators; Henschke, C. I.; Yankelevitz, D. F.; Libby, D. M.; Pasmantier, M. W.; Smith, J. P.; Miettinen, O. S. (2006). "Survival of Patients with Stage I Lung Cancer Detected on CT Screening". New England Journal of Medicine. 355 (17): 1763–1771. doi:10.1056/NEJMoa060476. PMID   17065637. S2CID   28552189.
  8. ↑ American Cancer Society, Surveillance Research, 2006
  9. ↑ "Homepage - American Lung Association". lungusa.org. Archived from the original on 2010-05-06. Retrieved 2022-01-10.
  10. ↑ US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.
  11. ↑ Ernst, Armin; Silvestri, Gerard A.; Johnstone, David (2003). "Interventional Pulmonary Procedures". Chest. 123 (5): 1693–1694. doi: 10.1378/chest.123.5.1693 . ISSN   0012-3692. PMID   12740291. S2CID   39643448.
  12. ↑ Gildea, T; Mazzone, P; Karnak, D; Meziane, M; Mehta, A (2006). "Electromagnetic Navigation Diagnostic Bronchoscopy: A Prospective Study". American Journal of Respiratory and Critical Care Medicine. 174 (9): 982–989. doi:10.1164/rccm.200603-344oc. PMC   2648102 . PMID   16873767.
  13. ↑ Wilson, D; Bartlett, R (2007). "Improved Diagnostic Yield of Bronchoscopy in a Community practice: Combination of Electromagnetic Navigation System and Rapid On-Site Evaluation". Journal of Bronchology. 14 (4): 227–232. doi: 10.1097/lbr.0b013e31815a7b00 .
  14. ↑ Lamprecht, Bernd; Porsch, Peter; Pirich, Christian; Studnicka, Michael (2009). "Electromagnetic Navigation Bronchoscopy in Combination with PET-CT and Rapid On-site Cytopathologic Examination for Diagnosis of Peripheral Lung Lesions". Lung. 187 (1): 55–59. doi:10.1007/s00408-008-9120-8. PMID   18836886. S2CID   25076936.
  15. ↑ Gildea, Thomas R.; Mazzone, Peter J.; Karnak, Demet; Meziane, Moulay; Mehta, Atul C. (2006). "Electromagnetic Navigation Diagnostic Bronchoscopy". American Journal of Respiratory and Critical Care Medicine. 174 (9): 982–989. doi:10.1164/rccm.200603-344OC. PMC   2648102 . PMID   16873767.
  16. ↑ D. Makris (2007). "Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions". European Respiratory Journal. 29 (6): 1187–1192. doi: 10.1183/09031936.00165306 . PMID   17360724.
  17. ↑ O'Donoghue, Kilian; Eustace, David; Griffiths, James; O'Shea, Michael; Power, Timothy; Mansfield, Hilary; Cantillon-Murphy, Padraig (2014). "Catheter Position Tracking System Using Planar Magnetics and Closed Loop Current Control". IEEE Transactions on Magnetics. 50 (7): 1–9. Bibcode:2014ITM....5004271O. doi:10.1109/TMAG.2014.2304271. S2CID   30051636.
  18. ↑ zwonull media GbR. "cars-int.org: CARS 2013". cars-int.org. Archived from the original on 2014-03-18.
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