PURPOSE:To investigate the diagnostic yield of electromagnetic navigation bronchoscopy and its associated complications in peripheral lung lesions deemed otherwise unapproachable using conventional bronchoscopy.
METHODS:Biopsy results were obtained from 32 patients undergoing electromagnetic navigation bronchoscopy (ENB) for peripheral lung lesions. Three different operators trained in electromagnetic navigation performed the procedures from 2006 to 2008, with a period of inactivity while the device was withdrawn from the market. ENB was reserved only for use in lesions at 4th order of bronchi or beyond, including sub-pleural lesions. Pathologic, cytologic, and microbiologic studies were carried out on recovered samples. Post-procedural chest radiographs were obtained on all subjects to detect the presence of any procedure associated complications.
RESULTS:Electromagnetic navigation bronchoscopy provided a diagnostic biopsy sample for 24 of 32 (75%) patients with suspicious peripheral lung lesions not amenable to conventional bronchoscopic biopsy. Of the 24 patients diagnosed via the procedure, eleven lesions were found to be malignant (46%), five lesions were infectious (21%), and eight lesions were free of malignancy or infection (33%). The predominant malignancy identified was non-small cell lung cancer, consistent with this malignancy's traditional peripheral location. Eight patients (25%) could not be diagnosed via electromagnetic navigation bronchoscopy and required further biopsy by surgery or interventional radiology, yielding predominantly non-small cell lung cancers. Additionally, only 3 (9%) patients experienced a procedure–associated pneumothorax, two of which required the insertion of a chest tube.
CONCLUSION:Electromagnetic navigation bronchoscopy is an effective and low risk modality for diagnosing difficult to reach pulmonary lesions. Although no clear criteria for the use of electromagnetic navigation bronchoscopy currently exists, our study demonstrates that diagnostic sampling can be obtained in 75% of lesions at 4th order of bronchi or beyond, including sub-pleural lesions.
CLINICAL IMPLICATIONS:Electromagnetic navigation bronchoscopy is an effective, minimally invasive method for the diagnosis of pulmonary nodules previously deemed unreachable by conventional bronchoscopy with low complication rates.
DISCLOSURE:Amit Mahajan, No Financial Disclosure Information; No Product/Research Disclosure Information