PURPOSE: Diagnosis of PLL is complicated by the ability of conventional bronchoscopy to effectively navigate to them. The current report describes the use of EMB coupled with REBUS for diagnosis of PLL (6 mm to 60 mm, mean diameter 23 mm) in 48 patients (pt) (22 females and 26 males from ages 46 to 84).
METHODS: EMB was performed via Superdimension™ by registering virtual 3D points at entrances to various bronchial segments. The pt's 3D thorax CT was then superimposed on real time pt anatomy. The virtual CT served as the map to navigate to the PLL under EMB guidance. Olympus REBUS was then inserted into the working channel to confirm proper location and biopsies were performed.
RESULTS: In 42 pt, we successfully navigated to and biopsied PLL. There were 19 (45%) true positives (17 non-small cell carcinomas (NSCLC), 2 metastatic C); 19 (45%) true negatives (18 infections and 1 vascular abnormality identified by REBUS); 4 (10%) false negatives (1 NSCLC, 1 metastatic C, 1 leukemia diagnosed via thoracotomy, and 1 NSCLC diagnosed by routine bronchoscopy 1 yr later); and 0% false positives. In true negative pt, the PLL regressed with antimicrobial therapy. We were unable to navigate to PLL in 6 (13%) pt due to mechanical limitations of EMB (5 in the upper lobes). Four pt were diagnosed with NSCLC via thoracotomy. One pt was not a surgical candidate and had a positive PET scan. One pt chose antimicrobial therapy and had PLL regression after 16 months.
CONCLUSION: The combination of EMB and REBUS provides a high (90%) diagnostic rate (sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 83%) for accessible PLL with minimal complications (1 small pneumothorax). An estimated 32 thoracotomies were averted with these procedures resulting in significant cost savings (∼$700,000).
CLINICAL IMPLICATIONS: The concomitant use of EMB and REBUS averts the routine use of invasive diagnostic surgical procedures. This translates into significant health care cost savings and decreased pt morbidity and mortality.
DISCLOSURE: Theodore McLemore, No Financial Disclosure Information; No Product/Research Disclosure Information