A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): A human feasibility study.
BACKGROUND
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency.


OBJECTIVE
To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans.


METHODS
Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded.


RESULTS
Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered.


CONCLUSIONS
Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation.
Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Department of Medicine, Levanger Hospital, North-Trøndelag Health Trust, Norway.
Hanne
http://orcid.org/0000-0002-9968-3491
H
Sorger
Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway.
Erlend Fagertun
EF
Hofstad
Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Tore
T
Amundsen
Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway.
Thomas
T
Langø
Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway.
Janne Beate Lervik
JB
Bakeng
Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Håkon Olav
HO
Leira
D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation / Q000379:methods*; D008175:Lung Neoplasms / Q000473:pathology*; D064847:Multimodal Imaging / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods