Bronchoscopic Biopsy of Solitary Pulmonary Nodules with No Leading Airway Path

Introduction: One of the challenges to bronchoscopic biopsy of Solitary Pulmonary Nodule (SPN) where there is no airway leading to the nodule or no CT bronchus sign has been the ability to access the SPN, which is reflected in the low diagnostic yield (31%; Seijo, L.M. et al. CHEST 2010; 138(6):1316-1321). The Archimedes system (Broncus Medical) has been demonstrated to enable safe and accurate guided tunneling from the central airway wall through parenchyma to the SPN. Aims: Evaluate the diagnostic yield and safety of Bronchoscopic TransParenchymal Nodule Access (BTPNA) in patients with no leading airway path to the SPN, using Archimedes system. Methods: A series of 16 SPNs lack an airway path for biopsy was sampled by BTPNA using Archimedes system from October 2016 until January 2018 at 5 clinical sites. Trained bronchoscopist marked suspected SPN and selected suitable guided-bronchoscopy path to point of entry (POE) on airway wall. Hole creation and dilation at POE were performed prior to guide sheath insertion via the hole toward SPN under fused CT/Fluoroscopy guidance to get biopsy samples. Results: Overall diagnostic yield was 75% on SPNs with a mean major axis of 18.9±10.0 mm without major complications or pneumothorax. Conclusion: The results of this evaluation shows significant improvements over existing guided transbronchial biopsy in diagnosing SPN without CT bronchus sign. With additional experience in BTPNA procedures, we anticipate further improvement in diagnostic yield and will be reported in the future.