Late Breaking Abstract - Needle based confocal laser endomicroscopy for the diagnosis of peripheral lung nodules by robotic navigational bronchoscopy

摘要

Robotic navigational bronchoscopy (RNB) allows for high navigational success but diagnostic yield remains moderate due to near-miss of the target lesion. Needle based confocal laser endomicroscopy (nCLE) allows real-time lung cancer detection at the needle tip. We aim to assess feasibility, safety and needle repositioning based on nCLE-guidance during robotic bronchoscopy to reduce the current near-miss rate. Patients with suspected peripheral lung cancer based on (PET-)CT-scan underwent fluoroscopy and radial EBUS guided RNB. After lesion detection, an 18G needle containing the CLE probe, imaged the target area followed by TBNA and biopsies. In case of non-lesional CLE-imaging, readjustment of the robotic bronchoscope was performed. 17 patients were included (final diagnosis n=15 cancer, n=1 epithelioid granuloma, n =1 non-diagnostic) with a mean lesion size of 15 mm (range 8-30 mm). No complications occurred. In 14/15 (93%) of patients with cancer, nCLE-imaging detected a malignant pattern. In one patient alveolar parenchyma/ airway wall was visualized. One patient with a malignant nCLE pattern but negative robotic bronchoscopic lesion sampling was diagnosed with malignancy after surgery. In 6 patients (35%), nCLE guidance resulted in readjustment of the robotic bronchoscope with optimization of the sampling location, resulting in a diagnostic yield of 82%, (14/17, 13 patients with malignancy and 1 patient with epithelioid granuloma). In conclusion, robotic navigational bronchoscopy combined with nCLE-imaging is feasible, safe and can serve as a real-time guidance tool to fine-tune the sampling location to improve the diagnosis of peripheral lung cancer.