CRA84 UNMASKING THE INDOLENT: FIRST MALAYSIAN EXPERIENCE WITH THE ARCHIMEDES™ BRONCHOSCOPIC NAVIGATION SYSTEM IN DIAGNOSING PERIPHERAL LUNG ADENOCARCINOMA

Nor Syamimi Mohd Isa, Noor Eliana Rozani, Am Basheeri Alias, Tan Chen Yong, Noor Emillia Illa, Suhashini Ganapathy, Leong Swee Wei, Mona Zaria Nasaruddin

Hospital Sultan Idris Shah,Serdang, Selangor, Malaysia.

Introduction
Slow-growing pulmonary nodules often pose a diagnostic dilemma, particularly in patients with multiple comorbidities and limited physiological reserve. In such scenarios, the risk associated with conventional biopsy techniques—such as CT-guided transthoracic biopsy or surgical resection—may outweigh potential diagnostic benefits. Emerging bronchoscopic navigation platforms offer minimally invasive alternatives that improve diagnostic yield in anatomically challenging lesions. This case reports the first successful use of the Archimedes™ bronchoscopic navigation system in Malaysia to diagnose peripheral lung adenocarcinoma.

Case Report
A 68-year-old man with ischemic heart disease, obstructive sleep apnea, and GOLD E COPD was followed for a solitary pulmonary nodule located in the lateral basal segment of the left lower lobe. First identified in 2022, the lesion demonstrated slow interval growth, increasing in size to 14 mm by early 2025. PET-CT revealed a non-FDG avid nodule, contributing further diagnostic uncertainty. Due to the lesion’s peripheral location and the patient’s compromised cardiopulmonary status, CT-guided biopsy and surgical resection were deemed high risk. The Archimedes™ bronchoscopic navigation system was employed, enabling accurate targeting and transbronchial sampling of the lesion with no complications. Histopathological examination confirmed primary lung adenocarcinoma.

Discussion
This case illustrates the growing role of advanced bronchoscopic navigation systems in the diagnostic pathway for difficult-to-access pulmonary lesions, especially in high-risk patients. The Archimedes™ platform combines CT-based 3D airway reconstruction, virtual bronchoscopy, and real-time fluoroscopic guidance to enhance precision and safety. In this patient, it bridged the gap between inconclusive imaging and definitive tissue diagnosis, while avoiding more invasive procedures. This experience supports the broader adoption of navigational bronchoscopy in complex thoracic oncology cases where traditional approaches may be contraindicated.