The diagnostic yield of Electromagnetic Navigational Bronchoscopy (ENB) for peripheral pulmonary lesions has been reported to range between 59 and 74%. Most experience is derived from international studies, and none has reported the utility of this technique in the US veteran population. The objective of our study is to determine the diagnostic yield of ENB in the workup of peripheral lung nodules in high risk VA patients.
All patients referred for ENB with a peripheral lung lesion deemed difficult to reach with standard bronchoscopic technique at the Oklahoma City VA hospital between February 2008 and April 2009 were included. The procedure was performed using a superDimension Inc ENB system (Minneapolis, MN). Real-time reconstitution of previous CT scan images was used for navigation. Patients’ demographics, as well as procedure related characteristics were recorded. The primary end point of our analysis was the diagnostic yield (sensitivity) of the ENB.
A total of 33 male patients (mean age of 69 years) were identified. Mean nodule size was 2.5 ± 1.1 cm. Lesions were an average of 3.4 ± 1.7 cm from the pleural surface. The mean error margin was 4.5 ± 0.8 mm. 82% of the lesions were reached, with probe-target distance of 8.3 ± 8.1 mm. A definitive diagnosis was obtained in 15 cases (45%, 95% CI 28–64%), including 13 cases of bronchogenic carcinoma (39%). The diagnostic yield was not influenced by the error margin, but was affected by the probe to target distance (5.1 vs.11.3 mm, p < 0.03). Of the 18 non diagnostic cases, 6 were diagnosed with bronchogenic carcinoma using transthoracic needle aspiration, while open surgical excision diagnosed one bronchogenic carcinoma and two benign diagnoses. The workup of the remaining 9 undiagnosed patients is still pending. Pneumothorax occurred in two patients (6%).
In our experience, ENB appears to have a lower diagnostic yield compared to previously published data.
Lesion and operator dependant factors need to be identified in order to justify the role of ENB in the work up of peripheral pulmonary nodules.
Rami Hanna, No Financial Disclosure Information; No Product/Research Disclosure Information