REVIEW  COMPETENCE IN INTERVENTIONAL PULMONOLOGY Free access

Panminerva Medica 2019 September;61(3):280-9

DOI: 10.23736/S0031-0808.18.03568-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Competence in navigation and guided transbronchial biopsy for peripheral pulmonary lesions

Vanina LIVI ¹ ✉, Emanuela BARISIONE ², Lina ZUCCATOSTA ³, Micaela ROMAGNOLI ⁴, Alessia PRATICÒ ⁵, Lucio MICHIELETTO ⁶, Laura MANCINO ⁶, Lorenzo CORBETTA ⁷

¹ Pneumologia Interventistica Interaziendale, Policlinico S. Orsola Malpighi, Maggiore Hospital, Bologna, Italy; ² UOC Pneumologia, Ospedale Policlinico San Martino, Genoa, Italy; ³ Operative Unit of Pneumology, Ospedali Riuniti University Hospital, Ancona, Italy; ⁴ Operative Unit of Interventional Pneumology, Policlinico Sant’Orsola-Malpighi Hospital, Bologna, Italy; ⁵ Operative Unit of Pneumology, Perugia University Hospital, Perugia, Italy; ⁶ Operative Unit of Pneumology, Ospedale dell’Angelo, Mestre, Venice, Italy; ⁷ Operative Unit of Interventional Pneumology, University of Florence, Florence, Italy

Options for non-surgical tissue diagnosis of the peripheral nodule include CT scan-guided TTNA, fluoroscopy-guided bronchoscopy, radial endobronchial ultrasound (EBUS), electromagnetic navigation bronchoscopy (ENB), and virtual bronchoscopy navigation (VBN). For physicians who choose to pursue non-surgical biopsy, the decision to perform CT scan-guided or ultrasound-guided TTNA, conventional bronchoscopy or bronchoscopy guided by EBUS, ENB, or VBN will depend on a number of factors. CT scan-guided TTNA is preferable for nodules located near the chest wall or for deeper lesions, provided that there is no need to go through the fissures and there is no surrounding emphysema. Ultrasound-guided TTNA requires contact between the lesion and the costal pleura. Bronchoscopic techniques are preferable for nodules ≥2 cm located near a patent bronchus, or in individuals at high risk for pneumothorax following TTNA. In most other situations, operator experience should guide the decision. Trainees must possess a perfect knowledge of anatomy and be fully competent in the interpretation of imaging (CT with contrast medium and PET) and have a thorough knowledge of navigation technology in all its complexities. Practical training can be performed on animal, cadaver or plastic models. In the last years, to improve diagnostic yield, navigational bronchoscopy has attracted significant attention.

KEY WORDS: Bronchoscopy - Multiple Pulmonary Nodules - Single Pulmonary Nodule - Education - Clinical Competence