PURPOSE: To evaluate the safety and diagnostic yield of Electromagnetic navigation bronchoscopy (ENB) and to determine if nodule characteristics affect the yield of ENB.
METHODS: Retrospective analysis of the last 21 consecutive ENB procedures from each institution. Procedures were done with the Super Dimension™ system per each institution's standard protocol. Data collected were: patient demographics, nodule size, nodule distance from the pleura, complications, samples obtained, diagnosis and follow-up studies. Diagnostic yield was calculated as: yield = success/total procedures x 100. Success was defined as a specific benign or malignant diagnosis or a non-specific benign biopsy proven by further sampling, regression on CT scanning or stability on CT scanning ≥ 6 months from the time of ENB.
RESULTS: 63 patients from three centers were evaluated. The average nodule size was 2.58 ± 1.25 cm and they were on average 1.86 ± 1.16 cm from the pleura. The overall yield for ENB guided sampling of pulmonary nodules was 60% (38/63; 5 successes were non-diagnostic but had resolution or stability on subsequent CT scanning). There was no significant difference between the institutions in diagnostic yield. A non-significant increase in diagnostic yield was observed with conscious sedation vs. propofol (68% vs. 48%; p = 0.43) although cases using propofol involved significantly smaller nodules (2.82 ± 1.36 cm vs. 2.15 ± 0.90 cm; p = 0.04). ENB yield for nodules ≤ 2 cm vs. > 2 cm was significantly worse (33% vs. 77%; p = 0.001). Distance from the pleura and lobar location of the nodule did not affect diagnostic yield. The complication rate was 6.3% (3 pneumothoraces; 1 episode of bleeding) but none required hospitalization. The pneumothorax rate was not affected by distance from the pleura.
CONCLUSION: ENB guided sampling of pulmonary nodules is an improvement on standard bronchoscopic biopsy that is safe and not affected by the location of the nodule. Nodule size does adversely affect the yield of ENB.
CLINICAL IMPLICATIONS: ENB is another tool aiding in the diagnosis of pulmonary nodules.
DISCLOSURE: Kurt Jensen, No Financial Disclosure Information; No Product/Research Disclosure Information