PURPOSE:Electromagnetic Navigation Bronchoscopy (ENB) increases yield for pulmonary nodules. Variable yields in the literature maybe due differences in technique unrelated to ENB. Most report transbronchial biopsies (TBBx) but others have used multiple sampling techniques. This study assesses Cytology brush (CB) and TBBx on the yield of electromagnetic navigation bronchoscopy.
METHODS:109 patients enrolled in a published prospective trial (Gildea et al. AJRCC 2006) and consecutive additional cohort patients were included. If patients had multiple procedures; only the first was used. All procedures were done with conscious sedation. Standard CB, forceps TBBx and needle cytology instruments, if possible in that order was used. C-arm fluoroscopy was used to confirm instrument function or displacement. The outcome was yield differences in sampling technique between CB and TBBx and overall yield. Diagnostic success was defined as positive cancer diagnosis, a non-cancer diagnosis, and plausible non-diagnostic result with negative follow-up. 50% of those had passed 1 year or had been proven to be non-malignant.
RESULTS:109 patients underwent electromagnetic navigation bronchoscopy for biopsy on 126 peripheral lesions. 45% of the patients were female, median age was 66 years. Mean lesion size was 21.6 mm(SD ±11.3mm). The mean CT- body error was 5.56mm (SD ±1.86mm). Overall diagnosis by patient was a 76.8% and by lesion 76.2%. Cancer was diagnosed in 44.4% of patients. Cancer prevalence was 67.7%. Among 41 lesions some combination of TBBX and CB resulted in a malignancy but discordance was present in 20 where 12 cancers were diagnosed with the CB were the TBBX was negative; and 8 were diagnosed with the TBBX where CB was negative. Yield did no differ by lobar location.
CONCLUSION:The use of CB and TBBX has incremental but disparate value detecting cancer with ENB.
CLINICAL IMPLICATIONS:Reaching peripheral lesions favors flexible instruments with ENB. As the cytology brush is the most flexible among the standard instruments its use and others have incremental increase on yield. All instruments should be used despite ENB.
DISCLOSURE:Rania Abdallah, Consultant fee, speaker bureau, advisory committee, etc. Speaker Bureau- Physician Education- I recieve a fee per session to instruct new users at SuperDimension on the use of electromagnetic navigation.; No Product/Research Disclosure Information