Navigated ultrasound bronchoscopy with integrated positron emission tomography - A human feasibility study

Patients suspected to have lung cancer undergo endobronchial ultrasound
bronchoscopy (EBUS) for the purpose of diagnosis and staging. For
presumptive curable patients, the EBUS bronchoscopy is planned based on
images and data from computed tomography (CT) images and positron emission
tomography (PET). Our study aimed to evaluate the feasibility of a
multimodal electromagnetic (EM) navigation platform for EBUS bronchoscopy,
integrating ultrasound and segmented CT, and PET scan imaging data. This
proof-of-concept study included patients with suspected lung cancer
identified on both CT and PET scans. Images obtained from these two
modalities were segmented to delineate target lymph nodes and then
incorporated into the CustusX navigation platform. The EBUS bronchoscope
was equipped with a 3D printed click-on device with an integrated EM
sensor at the tip. Navigation accuracy was measured postoperatively using
ultrasound recordings. The study enrolled three patients, all presenting
with suspected mediastinal lymph node metastasis (N1-3). All PET-positive
lymph nodes were displayed in the navigation platform during the EBUS
procedures. In total, five distinct lymph nodes were sampled, yielding
malignant cells from three nodes and lymphocytes from the remaining two.
The median accuracy of the navigation system was 7.7 mm. Our study
introduced a feasible multimodal electromagnetic navigation platform that
combines intraoperative ultrasound with preoperative segmented CT and PET
imaging data for EBUS lymph node staging examinations. This innovative
approach holds promise for enhancing the accuracy and effectiveness of
EBUS procedures.