title: Use of Electromagnetic Navigational Transthoracic Needle Aspiration (E-TTNA) for Sampling of Lung Nodules.
abstract: Lung nodule evaluation represents a clinical challenge especially in patients with intermediate risk for malignancy. Multiple technologies are presently available to sample nodules for pathological diagnosis. Those technologies can be divided into bronchoscopic and non-bronchoscopic interventions. Electromagnetic navigational bronchoscopy is being extensively used for the endobronchial approach to peripheral lung nodules but has been hindered by anatomic challenges resulting in a 70% diagnostic yield. Electromagnetic navigational guided transthoracic needle lung biopsy is novel non-bronchoscopic method that uses a percutaneous electromagnetic tip tracked needle to obtain core biopsy specimens. Electromagnetic navigational transthoracic needle aspiration complements bronchoscopic techniques potentially allowing the provider to maximize the diagnostic yield during one single procedure. This article describes a novel integrated diagnostic approach to pulmonary lung nodules. We propose the use of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging; radial EBUS, navigational bronchoscopy and E-TTNA during one single procedure to maximize diagnostic yield and minimize the number of invasive procedures needed to obtain a diagnosis. This manuscript describes in detail how the navigation transthoracic procedure is performed. Additional clinical studies are needed to determine the clinical utility of this novel technology.
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Sixto
authors.initials: S
authors.lastname: Arias
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Hans
authors.initials: H
authors.lastname: Lee
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Roy
authors.initials: R
authors.lastname: Semaan
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Bernice
authors.initials: B
authors.lastname: Frimpong
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ortiz
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Karen
authors.initials: K
authors.lastname: Oakjones-Burgess
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University; lyarmus@jhmi.edu.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
mesh_terms: D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods*; D055590:Electromagnetic Phenomena; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D009339:Needles; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000473:pathology*