ORIGINAL RESEARCH article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1628410
Archimedes Navigation System-Guided Bronchoscopic Trans-Parenchymal Nodule Access (BTPNA) for Peripheral Lung Nodules: A Single-Center Experience
Provisionally accepted
Ping-Tsung Yu1Sheng Hsiung Yang1Hui-Hsuan Shi1Wei Ming Huang1,2,3Jie-Yang Jhuang4Mei-Lin Chan1,2*
Wen-Chien Huang1,2*- 1MacKay Memorial Hospital, Taipei, Taiwan
- 2MacKay Medical College, New Taipei City, Taiwan
- 3MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
- 4MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
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Background: Peripheral pulmonary lesions (PPLs) present diagnostic challenges because of their small size and distal airway location, often requiring invasive surgical biopsies. The Archimedes™ navigation system assists the bronchoscopic trans-parenchymal nodule access (BTPNA) procedure, offering a minimally invasive alternative for diagnosing PPLs. Methods: This retrospective study evaluated the safety and efficacy of BTPNA guided by the Archimedes™ navigation system in 10 patients with single PPLs (<20 mm) and no bronchus signs. Preoperative CT scans were used to create a 3D virtual airway model, identify an optimal point of entry (POE), and plan an avascular pathway to the nodule. The procedure combined virtual bronchoscopy, real-time fluoroscopy, and radial endobronchial ultrasound (R-EBUS). Tissue samples were collected for histopathological analysis, and complications were monitored post-procedure. Results: A total of 10 patients (median age: 54.5 years) were included, with a diagnostic yield of 70.0%. Successful diagnoses included adenocarcinoma in situ, granulomatous inflammation, and invasive adenocarcinoma. No complications were observed. The mean size of the nodular lesions in the 10 cases was 13.9 mm. Median distances were 12.9 mm from pleura to target lesion, and median tunnel length was 57.8 mm. Conclusions: The Archimedes™ system-guided BTPNA is safe and effective for diagnosing small PPLs without bronchus signs, demonstrating precise localization and tissue sampling while minimizing invasiveness. No complications were observed, highlighting the procedure's safety. Larger prospective studies are warranted to validate these findings and refine patient selection and procedural techniques to optimize outcomes.
Keywords: Archimedes navigation system, Bronchoscopic trans-parenchymal nodule access (BTPNA), diagnostic yield, peripheral pulmonary lesion (PPL), virtual bronchoscopic navigation (VBN)
Received: 14 May 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Yu, Yang, Shi, Huang, Jhuang, Chan and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Mei-Lin Chan, MacKay Memorial Hospital, Taipei, Taiwan
Wen-Chien Huang, MacKay Memorial Hospital, Taipei, Taiwan
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