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Pulmonary Procedures |

Diagnostic Yield of Transbronchial Biopsy in a University Training Program Before and After Initiation of Electromagnetic Navigational Bronchoscopy

Sivaraman Sivaswami, MBBS; Adam Wellikoff, MD; Robert Holladay, MD
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Lousiana State University Health Sciences Center, Shreveport, LA


Chest. 2013;144(4_MeetingAbstracts):807A. doi:10.1378/chest.1700747
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Abstract

SESSION TITLE: Bronchoscopy and Interventional Procedures Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Transbronchial biopsy (TBB) is a routine part of training in pulmonary medicine fellowships; however, the yield when used for lung nodules and masses has been limited. Recent technology allows more guided biopsies to increase the diagnostic yield from isolated lung lesions. Learning these techniques requires additional training. We compared the use of electromagnetic navigational bronchoscopy (ENB) in our training program with traditional TBB after initiating ENB into our program.

METHODS: Consecutive patients between ages 18 and 95 who had TBB performed with and without ENB between May 1, 2010 and May 31, 2012 were reviewed. Diagnostic tissue was determined by identifiable pathology, or by clinical resolution or stability noted on subsequent follow-up up to 8 months after the procedure. Diagnostic yield was defined as Diagnostic tissue/Total sampled.

RESULTS: A total of 58 TBBs were performed without ENB of which 30 were performed in the first year and 28 in the second year. Three patients were lost to follow up and there was incomplete data for one bronchoscopy. There were 33 with diagnostic tissue from TBB, 1 from endobronchial biopsy and 20 with non-diagnostic tissue. Diagnostic yield was 61%. The median size of lesion attempted that was positive was 4.6 cm. A total of 64 TBBs were performed with ENB and all were performed in the second year of the study. Four patients were lost to follow up. There were 36 with diagnostic tissue and 24 with non-diagnostic tissue. Diagnostic yield was 60%. The median size of the lesion attempted that was positive was 2.225 cm. The number of TBBs increased from 30 to 92 in the second year.

CONCLUSIONS: There was an increase in the number of all transbronchial biopsies in the second year. The diagnostic yields from blind versus guided transbronchial biopsies were equivalent. When comparing characteristics of the lesions in the two groups, however, we were able to obtain positive diagnoses from smaller lesions.

CLINICAL IMPLICATIONS: ENB is a useful adjunct to the transbronchial biopsy of smaller peripheral nodules.

DISCLOSURE: The following authors have nothing to disclose: Sivaraman Sivaswami, Adam Wellikoff, Robert Holladay

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