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Correspondence |

Electromagnetic Navigation Diagnostic Bronchoscopy and Transbronchial Biopsy FREE TO VIEW

Demosthenes Makris, MD; Konstantinos I. Gourgoulianis, MD
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Affiliations: University Hospital, Heraklion, Greece,  University of Thessaly Medical School, Thessaly, Greece

Correspondence to: Demosthenes Makris, MD, University Hospital, Voutes Heraklion, Heraklion, Greece 74110; e-mail: appollon7@hotmail.com


Chest. 2008;133(3):829-830. doi:10.1378/chest.07-1754
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To the Editor:

We read the article by Eberhardt et al1 (June 2007) with a lot of interest. The authors1 concluded that electromagnetic navigation diagnostic bronchoscopy (EMN) can be used as a stand-alone bronchoscopic technique without compromising diagnostic yield or increasing the risk of pneumothorax. In contrast to fluoroscopic guidance, the technique is not associated with radiation exposure, and the overall diagnostic yield reported for EMN12 is superior to rates reported previously for small peripheral pulmonary nodules with bronchoscopy.34 Thus, EMN may improve the diagnostic yield of transbronchial biopsy.

We seek the opinion of the authors on the following issues in order to further refine this technique. First, it is not yet clear whether the initial choice of registration points can improve further the diagnostic yield of EMN. Although in the study by Eberhardt et al1the registration process did not affect diagnostic accuracy, in a recent investigation2 diagnostic accuracy was affected by registration error. We believe that there should be some criteria regarding the number and characteristics of registration points, especially in cases where registration error is important (as in the case of 34 patients in the study by Eberhardt et al1). These criteria could be defined by scientific consensus based on published evidence.

Second, in a study2 that assessed EMN without additional guidance, there was no difference in terms of diagnostic accuracy between bronchoscopists. Is this also the case in the study by Eberhardt et al,1 especially considering that two centers participated in this investigation? In addition, was there a learning curve? If yes, an active participation of pulmonologists in educational courses should be greatly encouraged. Third, we would appreciate it if the authors could provide some additional data regarding the mean distance between the center of the lesion and the visceral pleura, so that we can have a better description of lesion characteristics.

Dr. Makris received 2,000 Euros for direction of a Super Dimension (Europe) GmbH clinical course in Germany.

Eberhardt, R, Anantham, D, Herth, F, et al (2007) Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions.Chest131,1800-1805
 
Makris, D, Scherpereel, A, Leroy, S, et al Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions.Eur Respir J2007;29,1187-1192
 
Baaklini, W, Reinoso, M, Gorin, A, et al Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules.Chest2000;117,1049-1054
 
Shure, D, Fedullo, PF Transbronchial needle aspiration of peripheral masses.Am Rev Respir Dis1983;128,1090-1092
 

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References

Eberhardt, R, Anantham, D, Herth, F, et al (2007) Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions.Chest131,1800-1805
 
Makris, D, Scherpereel, A, Leroy, S, et al Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions.Eur Respir J2007;29,1187-1192
 
Baaklini, W, Reinoso, M, Gorin, A, et al Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules.Chest2000;117,1049-1054
 
Shure, D, Fedullo, PF Transbronchial needle aspiration of peripheral masses.Am Rev Respir Dis1983;128,1090-1092
 
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