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Review
. 2017 Dec;6(3):109-118.
doi: 10.2217/lmt-2017-0012. Epub 2017 Dec 1.

Loss of flexion during bronchoscopy: a physical experiment and case study of commercially available systems

Conor O'Shea  1   1 , Kashif Ali Khan  2   2 , Josef Tugwell  1   1 , Pádraig Cantillon-Murphy  1   1 , Marcus P Kennedy  2   2
Affiliations
Review

Loss of flexion during bronchoscopy: a physical experiment and case study of commercially available systems

Conor O'Shea et al. Lung Cancer Manag. 2017 Dec.

Abstract

During routine endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedures, especially with biopsy of lymph nodes in or around the left upper lobe, frequent reports have noted the loss of ultrasound image and needle angulation leading to an inability to biopsy nodes visualised by EBUS. The aim of this research was to investigate and compare this loss of angulation with commercially available scopes. Bench-top experiments and a clinical case study demonstrated the varying loss of scope angulation, flexibility and manoeuvrability with different scopes and biopsy instruments leading to procedural implications. Improvements in both the EBUS scope and needle characteristics are required to overcome this limitation which has implications in bronchoscope navigation and the diagnostic yield of EBUS-TBNA.

Keywords: bronchoscope deflection; bronchoscope navigation; bronchoscopy.

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Conflict of interest statement

Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. Scopes used during the analysis.
(A) Olympus BF-1T160, (B) Pentax EB-1970UK, (C) Olympus BF-UC260FW [11–13].
<b>Figure 2.</b>
Figure 2.. Up angle deflections with 10 mm instrument extensions from distal tip analyzed with AutoCad®.
(A) No needle, (B) SmoothShot, (C) eXcelon, (D) Radial Jaw 4, (E) Captura, and (F) Olympus Alligator Jaw.
<b>Figure 3.</b>
Figure 3.. Diagram of endobronchial ultrasound scope manipulation experiment set-up.
<b>Figure 4.</b>
Figure 4.. A 69-year-old male with cT3N2M0 non-small-cell lung cancer of his left upper lobe.
(A) Coronal computed tomography (CT) thorax with contrast displays the left upper lobe mass and enlarged mediastinal & hilar lymph nodes. (B) Axial fused PET-CT image reveals an fluorodeoxyglucose (FDG) avid 5.2 cm mass in the left upper lobe. (C & D) Axial fused PET-CT image identifies low grade FDG avid lymph node station at 4 and 10 L, respectively.
<b>Figure 5.</b>
Figure 5.. Average Olympus BF-1T160 up and down tip deflection with and without endoscopic instruments present in the working channel.
<b>Figure 6.</b>
Figure 6.. Example of reduced Olympus scope tip deflection.
(A) Up angle with no needle, and (B) up angle with 21 Ga Olympus needle positioned in working channel. A 56% reduction can be seen on introduction of the Olympus aspiration needle extended 15 mm beyond the distal tip. Adapted with permission from [25].
<b>Figure 7.</b>
Figure 7.. Comparison of reduced tip deflection for the Pentax and Olympus EBUS scope with the manufacturer's specifications (left), a free working channel (middle) and a 22 Ga aspiration needle (right).
Adapted with permission from [25].
<b>Figure 8.</b>
Figure 8.. Clinical results demonstrating loss of scope angulation.
(A) 5.2 mm mass located at lymph node station 10 L identified by EBUS, and (B) EBUS coupling lost once needle is inserted through working channel.
See this image and copyright information in PMC

References

    1. Yarmus L, Feller-Kopman D. Bronchoscopes of the twenty-first century. Clin. Chest Med. 2010;31(1):19–27. - PubMed
    1. Cameron SE, Andrade RS, Pambuccian SE. Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology. 2010;21(1):6–26. - PubMed
    1. Adams K, Shah PL, Edmonds L, Lim E. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax. 2009;64(9):757–762. - PubMed
    1. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795–798. - PMC - PubMed
    1. Medford AR. Endobronchial ultrasound-guided transbronchial needle aspiration. Int. J. Clin. Pract. 2010;64(13):1773–1783. - PubMed

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