• Users Online:833
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
IMAGE IN EUS
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 156-157

Convex probe endobronchial ultrasound placement of fiducial markers for central lung nodule (with video)


1 Department of Medicine, Interventional Pulmonary Section, Roswell Park Cancer Institute; Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA
2 Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
3 Department of Medicine, Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, New York, USA
4 Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA

Date of Submission06-Sep-2014
Date of Acceptance09-Oct-2014
Date of Web Publication8-May-2015

Correspondence Address:
Kassem Harris
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York, Buffalo, New York
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.156757

Rights and Permissions

How to cite this article:
Harris K, Gomez J, Dhillon SS, Alraiyes AH, Picone A. Convex probe endobronchial ultrasound placement of fiducial markers for central lung nodule (with video). Endosc Ultrasound 2015;4:156-7

How to cite this URL:
Harris K, Gomez J, Dhillon SS, Alraiyes AH, Picone A. Convex probe endobronchial ultrasound placement of fiducial markers for central lung nodule (with video). Endosc Ultrasound [serial online] 2015 [cited 2019 Oct 18];4:156-7. Available from: http://www.eusjournal.com/text.asp?2015/4/2/156/156757

An 80-year-old man was found to have a 1.4 cm lesion on right side of the lower lobe central parenchymal lung nodule on chest computed tomogram (CT) while undergoing evaluation for a cough [Figure 1]a and b. The lesion was metabolically active on positive emission tomography without any evidence to suggest involvement of mediastinal/hilar nodes or distant metastasis. Flexible bronchoscopy with transbronchial biopsies confirmed this lesion to be lung adenocarcinoma. The patient's comorbidities precluded surgical resection, and he was scheduled to have stereotactic body radiation therapy (SBRT). Given the central location of the nodule and its close proximity to the esophageal wall, fiducial markers placement inside the tumor was recommended. Convex probe endobronchial ultrasound (CP-EBUS) was used to place three fiducial gold markers (0.35 mm × 5 mm, Visicoil, IBA) using a 22 Gauge EBUS needle (Olympus, NA-201SX-4022). The fiducials were loaded into the EBUS needle distally (front-load), and bone wax was applied to secure the fiducials in place [Figure 1]c and d. Under real-time CP-EBUS guidance [Video 1], each fiducial was placed inside the tumor at a peripheral location forming a triangular shape inside the tumor [Figure 2]a-c. Color Doppler was used to prevent vascular puncture or accidental intravascular fiducial placement. The procedure time was about 30 min, and the patient reported no operation-related complications and the fiducials showed no evidence of migration [Figure 2]d-f. The patient underwent SBRT (how many fractions) without any complications.
Figure 1. (a and b) Chest computed tomography axial and coronal views showing the right lower lobe central nodule. (c) Convex probe endobronchial ultrasound (CP-EBUS) image showing the fi ducial marker inside the tumor (arrow). (d) Intraoperative fluoroscopic image showing the tip of the EBUS scope (red arrow) and the three fi ducial markers that were placed using CP-EBUS (white arrows)

Click here to view
Figure 2. (a-c) Convex probe endobronchial ultrasound images showing the EBUS needle (arrows) at different locations inside the tumor representing where the three fi ducials markers were deployed. (d-f) Images from the stereotactic body radiation therapy planning scan showing the fi ducial markers inside the tumor (arrows)

Click here to view





Surgical resection remains the first-line treatment for early-stage peripheral lung cancer.

In patients with multiple comorbidities that preclude surgery, alternative therapy such as SBRT is considered. Fiducial markers placement for lung cancers is commonly performed to guide SBRT or surgical resection. Percutaneous CT-guided fiducial placement is associated with pneumothorax rate up to 48%. [1] Since advanced bronchoscopic techniques provide improved diagnostic accuracy and fewer complications over conventional bronchoscopy, they are now more commonly used for fiducial markers placement to guide radiation therapy. Both radial probe EBUS and electromagnetic navigation have been used for implanting of fiducial markers. [2] These devices may be used as markers to guide radiation therapy. The complication rate such as migration and pneumothorax is, usually, low. [3] In one group, 90% of the markers remained in place during the time of radiosurgery. [4]

CP-EBUS is widely used for the diagnosis and mediastinal staging of lung cancer. CP-EBUS has been also used to guide fiducial markers placement in the peribronchial and mediastinal lymph nodes. [5] CP-EBUS can be utilized for diagnosis of central parenchymal lung nodules and masses, along with simultaneous mediastinal staging. In these cases, fiducial markers placement can be performed in the same setting using CP-EBUS as no complications have been reported. [5],[6]

Convex probe endobronchial ultrasound placement of fiducial markers is a safe and useful procedure to guide stereotactic radiosurgery for centrally located lung cancers.

 
  References Top

1.
Pennathur A, Luketich JD, Heron DE, et al. Stereotactic radiosurgery for the treatment of stage I non-small cell lung cancer in high-risk patients. J Thorac Cardiovasc Surg 2009;137:597-604.  Back to cited text no. 1
    
2.
Harley DP, Krimsky WS, Sarkar S, et al. Fiducial marker placement using endobronchial ultrasound and navigational bronchoscopy for stereotactic radiosurgery: An alternative strategy. Ann Thorac Surg 2010;89:368-73.  Back to cited text no. 2
    
3.
Toba H, Kondo K, Miyoshi T, et al. Fluoroscopy-assisted thoracoscopic resection after computed tomography-guided bronchoscopic metallic coil marking for small peripheral pulmonary lesions. Eur J Cardiothorac Surg 2013;44:e126-32.  Back to cited text no. 3
    
4.
Anantham D, Feller-Kopman D, Shanmugham LN, et al. Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors: A feasibility study. Chest 2007;132:930-5.  Back to cited text no. 4
    
5.
McGuire R, Liming J, Ochran T, et al. Real-time endobronchial ultrasound-guided implantation of radiotherapy monitoring devices. J Bronchology 2007;1:59-62.  Back to cited text no. 5
    
6.
Tobias L, Decker R, Puchalski J. Convex probe endobronchial ultrasound for placement of intraparenchymal fiducial markers to guide stereotactic radiosurgery. Chest 2011;140:164A. [4_MeetingAbstracts].  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Detection of an embolized central venous catheter fragment with endobronchial ultrasound
Samjot Singh Dhillon,Kassem Harris,Abdul H. Alraiyes,Anthony L. Picone
The Clinical Respiratory Journal. 2018; 12(1): 295
[Pubmed] | [DOI]
2 Convex Endobronchial Ultrasound-Guided Fiducial Placement for Malignant Central Lung Lesions
Adam R. Belanger,Timothy Zagar,Jason A. Akulian
Journal of Bronchology & Interventional Pulmonology. 2016; 23(1): 46
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed914    
    Printed17    
    Emailed0    
    PDF Downloaded181    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]