PURPOSE: To evaluate the utility of using more than one tool to obtain diagnostic specimens when performing electromagnetic navigation bronchoscopy (ENB) and the value of the presence of a bronchus sign.
METHODS: We performed a retrospective review of patients who underwent ENB for diagnosis of peripheral lung nodules. We reviewed the planning CT for lesion size, presence of a bronchus sign - airway leading directly to the lesion, and the parietal pleura. We reviewed the procedure documentation for the distance of the working channel to the center of the lesion. All our ENB was performed under deep sedation. We used fluoroscopy to confirm position. Only 1 patient needed manual registration; the rest were done with automatic registration.
RESULTS: Thirteen patients were studied. The diagnostic yield of ENB was 69.2% (9/13). Diagnosis of cancer was 46% (6/13). Bronchus sign was present in 54% (7/13). Diagnostic yield was 85.7% (6/7) with the presence of the bronchus sign. The mean lesion size was 2.09 cm in diameter. Mean distance from parietal pleura was 3.62cm. Mean distance of the tip of the extended working channel from the center of the target was 1.18cm. Diagnostic yield in patients with cancer for the various tools were: Brush 83% (5/6), FNA 83% (5/6), forceps biopsy 83% (5/6), BAL 50% (3/6). Diagnostic yield in patients with non-malignant diagnosis for the various tools were: Brush 0%, FNA 33.33% (1/3), forceps biopsy 66.67% (2/3), BAL 33.33% (1/3).
CONCLUSIONS: The presence of a bronchus sign improves the yield of ENB from 69% to 85.7%. The use of multiple tools to obtain tissue improves the yield from the procedure. The yield from each tool is different for patients with a malignancy compared to other diagnoses.
CLINICAL IMPLICATIONS: Clinicians should review the chest CT for the presence of a bronchus sign which would help select patients who are more likely to benefit from the procedure. The use multiple tools to obtain tissue samples would improve the procedure yield.
DISCLOSURE: The following authors have nothing to disclose: Raed Alalawi, Saba Radhi, Thomas Stunkard, Kenneth Nugent
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