First European experience with C-arm based tomography for the diagnosis of peripheral nodules

The C-arm based tomography (LungVision, LV, Body Vision Medical LTD, Israel) is a navigation and real-time intraoperative imaging system that enables peripheral lung nodule biopsy. We retrospectively analyzed the bronchoscopies performed with LV over one year in our center to assess localization, safety and diagnostic accuracy of peripheral nodules. Procedures were conducted under deep sedation with a laryngeal mask, without muscle paralysis, using a 4.1 mm or 3.7 mm bronchoscope (Olympus). Localization was confirmed using radial endobronchial ultrasound (r-EBUS). Tissue sampling was performed with forceps and/or a 21 G needle. A specimen was considered diagnostic if it was confirmed to be malignant, specific benign (e.g., hyphae) or if non-specific findings showed improvement on 3-months follow-up imaging or were confirmed benign on subsequent diagnostic procedures. Out of 157 nodules, 130 (83%) were successfully localized. Overall diagnostic accuracy was 72%, with 70% in the first 50 nodules and 77% in the most recent 50 nodules. The diagnostic accuracy was 77% in the subgroup of localized nodules. Lesions averaged 18.63 mm (range: 5-30) and mostly localized in the upper lobes (66%). A single pneumothorax was reported (0.6%) while no bleeding events occurred. Our experience with LV demonstrated excellent safety, as well as high localization and diagnostic accuracy, considering the features of the nodules and the absence of muscle paralysis during the procedure. <table-wrap><object-id>erj;64/suppl_68/PA1635/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col></colgroup><tbody><tr><td><bold>Nodules Characteristics</bold></td><td><bold>N(%)</bold></td></tr><tr><td>Size ≤2 cm</td><td>102(65)</td></tr><tr><td> Solid Part Solid Ground Glass Cavitary </td><td> 118(75) 19(12) 9(6) 11(7) </td></tr><tr><td>Distance to pleura <2 cm</td><td>97(62)</td></tr><tr><td>Bronchus sign</td><td>79(50)</td></tr><tr><td>Localization confirmed by r-EBUS</td><td>130(83)</td></tr></tbody></table></table-wrap>