Computer-Tomographically Guided Fiberbronchoscopic Transbronchial Biopsy of Small Pulmonary Lesions: A Feasibility Study

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Abstract
Small pulmonary lesions localized in peripheral airways or lung parenchyma are mostly not visible by means of flexible or rigid bronchoscopy for they are distal to the inspectable airway caliber. Therefore fluoroscopy is necessary to direct the flexible biopsy forceps or biopsy needle to the lesion. Even a two-dimensional fluoroscopic guidance does not guarantee an access to the focus. Therefore we investigated a method to overcome these problems. In 9 patients with peripheral lung lesions where the conventional method had failed to provide sufficient biopsies CT-guided bronchoscopy was done. Central airways were carefully inspected, and the flexible forceps was introduced into the bronchial branch leading to the focus under fluoroscopic control. Then the forceps was localized in the axial plane by CT and guided directly to the lesion. Subsequently the forceps was opened and contact to the lesion was confirmed by CT scan before the biopsies were taken. Thus the three-dimensional control of the position of the forceps made it possible to get biopsies directly from the region of interest. The method provides the possibility of reaching even small peripheral lesions that have been missed by the conventional techniques, thereby, although technically more difficult for the examiner, providing a smaller risk of complications and no additional discomfort for the patient.

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