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Electromagnetic Navigational Bronchoscopy Arrives in the Northland

Electromagnetic navigational bronchoscopy (ENB) can locate, diagnose and stage pulmonary nodules previously inaccessible by standard bronchoscopy. Andrea Anthony, MD; Brian Ladesich, MD; and Justin Ranes, MD, FCCP; with Meritas Health Pulmonary Medicine are the first pulmonologists in the Northland to perform this advanced outpatient procedure.

“ENB supports North Kansas City Hospital’s lung cancer screening program,” Dr. Anthony says. “The standard approach has been to perform serial CT scans of peripheral bronchial airways containing pulmonary nodules because we couldn’t reach them with routine bronchoscopy. We had to monitor their growth and decide whether to send the patient to the OR for a biopsy or lobectomy. With ENB, we can locate, biopsy, diagnose and stage (via concurrent Endobronchial Ultrasound or EBUS) lesions as small as 1 cm in one minimally invasive, outpatient procedure. An early diagnosis means earlier staging and faster treatment. Patients also avoid an open thoracotomy or Video Assisted Thorascopic Surgery (VATS) surgical procedure that has an extensive recovery period.”

“With ENB, we can locate, biopsy, diagnose and stage (via concurrent Endobronchial Ultrasound or EBUS) lesions as small as 1 cm in one minimally invasive, outpatient procedure. An early diagnosis means earlier staging and faster treatment.”

Virtual Roadmap

  • Physician identifies lung nodule using multiple CT images
  • Virtual reconstruction of lung nodule and path
  • Lung nodule identified and map completed. Nodule movement shown during tidal breathing.
  • Endobronchial navigation to lesion
  • Endobronchial navigation to lesion
  • Transthoracic Needle Aspiration in process

ENB integrates virtual bronchoscopy with pre-procedure inspiratory and expiratory CT scans of the patient’s bronchial passageways. The system uses the scans to create a virtual 3-D roadmap. Following the map, the pulmonologists navigate a flexible catheter through a bronchoscope containing an extended working channel and into the bronchial tree until it reaches the lesion. An electromagnetic plate rotates over the patient and assists with tracking the catheter’s position.

North Kansas City Hospital invested in the latest ENB technology, which include GPS mapping on each of the system’s endobronchial accessories. “The catheter’s tip can be fitted with three interchangeable devices each equipped with GPS technology,” Dr. Anthony explains. “We use all three — needle, brush and forceps — to biopsy the cells because that gives us better results. If we can’t reach the lesion because the airway doesn’t quite lead to it, we can perform a percutaneous needle biopsy (SPINperc) and obtain a diagnosis and stage immediately.” North Kansas City is the only hospital in the metro area with SPINperc capabilities available all in one procedure.

ENB and EBUS

ENB is used in conjunction with endobronchial ultrasound (EBUS). “Most facilities use EBUS with navigational bronchoscopy to diagnosis and stage lung cancer,” Dr. Anthony says. “We’ll perform the EBUS procedure first so we can biopsy centrally located lymph nodes. If those lymph nodes are benign, we’ll move to the ENB procedure to biopsy the peripheral solitary pulmonary nodules. If the EBUS results indicate malignant lymph nodes, there’s no need to continue.” The pulmonologists can conduct both EBUS and ENB during a single one-hour procedure.

Expanded Use

If the nodule is malignant, ENB technology can be used to place fiducial markers around the lesion, allowing radiation oncologist to more accurately target external beam radiation using Calypso technology. The markers can also help thoracic surgeons locate small tumors that require resection.

Andrea Anthony, MD

Andrea Anthony, MDDr. Anthony earned her medical degree from the University of Kansas School of Medicine, where she also completed her residency and a fellowship in pulmonary/critical care. She has a special interest in asthma and is the only pulmonologist in the Kansas City area performing Bronchial Thermoplasty for asthma patients. To date she has completed several EBUS procedures and is excited about adding ENB with SPINPerc as a diagnostic tool to help advance early detection and treatment of lung cancer at North Kansas City Hospital.

To learn more, call 816.691.5098.