SESSION TITLE: Bronchoscopy Poster Discussions
SESSION TYPE: Original Investigation Poster Discussion
PRESENTED ON: Wednesday, October 28, 2015 at 11:00 AM - 12:15 PM
PURPOSE: The American Cancer Society reports that only 15% of all lung cancers are diagnosed at a localized stage. Electromagnetic navigation bronchoscopy™ procedures are rapidly being adopted in academic clinical settings and allow navigation to smaller, more peripheral lesions, potentially allowing earlier diagnosis. This study assessed outcomes in the first year of use of ENB™ procedures at a community practice and the impact of introducing the procedure at the clinical center.
METHODS: This retrospective, single-arm, single-center study evaluated 90 consecutive patients (92 lesions) who had undergone an ENB™ procedure using the superDimension™ navigation system in 2012.
RESULTS: Patients were 65.6% female (average age 65.6±10.9 years; smoking history in 75.6%). The average lesion size was 22.7±16.0 mm. The most common lesion location was the right upper lobe (34.8%). ENB™ procedures were conducted for fiducial marker placement in 5 patients, dye marking in 2, and for guided endobronchial ultrasound in 2 patients. The ENB™ procedure was unable to reach the target lesion in 7 patients (8.1%). ENB™ procedure-aided biopsy was attempted in 84/90 patients and yielded a diagnosis in 71/84, for a diagnostic yield of 84.5%. Diagnoses aided by the ENB™ procedure were 50.7% (36/71) malignant, 33.8% (24/71) inflammation, 8.5% (6/71) infection, and 7.0% (5/71) benign. Diagnosis of non-small-cell lung cancer was aided by the ENB™ procedure in 25 cases; of those, 84% were diagnosed at Stage 1-2. Pneumothorax occurred in 6/90 (6.7%); 5/90 required a chest tube (5.6%; including 4 patients with pleural lesions and 1 with end-stage emphysema). Four patients (4.4%) experienced minor bleeding. The sensitivity, specificity, positive predictive value, and negative predictive value of the ENB™ procedure to yield a definitive malignancy diagnosis based on 2-year follow-up were 89.7%, 100%, 100%, and 88.6%.
CONCLUSIONS: In this early experience, introduction of the ENB™ procedure at a community center was highly successful, providing high diagnostic yield and a relatively low rate of pneumothorax even in the first year of use. Biopsy aided by the ENB™ procedure contributed to the diagnosis of non-small-cell lung cancer at an earlier stage compared to prior reports.
CLINICAL IMPLICATIONS: This study suggests that the ENB™ procedure is appropriate for use in community practice and may ultimately improve patient prognosis by providing earlier diagnosis with a high degree of accuracy and low risk.
DISCLOSURE: Susan Garwood: Consultant fee, speaker bureau, advisory committee, etc.: Medtronic Nathanael Hevelone: Employee: Medtronic Kristin Hood: Employee: Medtronic Kevin McGinnis: Employee: Medtronic Sean Pidgeon: Employee: Medtronic Jeffrey Potkul: Employee: Medtronic
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