Electromagnetic Navigation Bronchoscopy (ENB) is an advanced technology that requires new skills. We assessed the yield of ENB in sampling peripheral lesions over time to estimate the learning curve of the institution and individuals and the impact of peripheral Radial Endobronchial Ultrasound (REBUS).
330 ENB procedures were performed in 327 patients to sample 344 peripheral pulmonary nodules at Cleveland Clinic between December 2004 and January 2009.ENB was performed with moderate sedation and fluoroscopy. Since the onset, new techniques, upgrades and additional techniques have been added. The procedures were performed by five pulmonologists. The final diagnosis was based on the histopathologic results of samples, if ENB was non diagnostic, by another diagnostic method or by clinical follow up. Lost to follow-up was considered a false negative. REBUS was added in August 2007 for operators B and D.
The mean age was 65.5 years. 48% were female. The mean lesions size was 20.6mm ± 9.2. The mean CT-Body error was 5.3mm ± 1.7. The outcome of ENB was diagnostic in 185 patients (55.8%). In an additional 69 (21%) although not diagnostic, no malignancy was found. ENB failed in 73 (22%). In the 81 cases where EBUS was performed yield was not significantly different 79% from non-EBUS cases. 77.1% (p = 0.72). Overtime the yield of ENB has varied but shows no systematic improvement despite new components.Figure 1. The diagnostic yield was not statistically significant 100%, 74.2, 72.7, 79.6%, and 83.3% per operator respectively (P-value = 0.5). There is evidence for learning curve for operator C. No evidence for learning curves for both operators B and D. Operator A and E learning curve can not be assessed due to small numbers. Table 1.
Using yield as a measure of learning curve is difficult to interpret. EBUS does not increase yield.
Despite evidence in other literature the yield of ENB appears to be unrelated to new components or learning curve.
Rania Abdallah, Consultant fee, speaker bureau, advisory committee, etc. Dr. Gildea receives fees of $5,000 or more per year as a paid consultant or speaker for the Superdimension companny.; No Product/Research Disclosure Information