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Pulmonary Procedures |

The Safety and Yield of Electromagnetic Navigational Bronchoscopy to Diagnose Peripheral Pulmonary Lesions: St. John Providence Hospital Experience

Alehegn Gelaye, MD; Karim Saleeby, DO; Prabhat Sinha, DO; Mohammed Farra, MD
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Providence Hospital, Southfield, MI


Chest. 2015;148(4_MeetingAbstracts):818A. doi:10.1378/chest.2280144
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Abstract

SESSION TITLE: Interventional Pulmonology Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The diagnostic yield of conventional bronchoscopy for solitary pulmonary lesions <2 cm and located in the outer third of the lung does not exceed 30%. Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. The overall published diagnostic yield and rate of pneumothorax of ENB is between 59 to 77.3% and < 10%, respectively. In this study, we sought to determine the yield and safety of all ENB at Providence hospital and medical center since its acquisition in 2012.

METHODS: All adults age 18 years and older who underwent ENB for peripheral pulmonary lesions, which are not reached by conventional bronchoscopy from September 2012 at the Providence hospital and medical center were included in the study. A Retrospective chart review of patients from September 2012 to January 2015 was performed. Chest imagings, operative notes, microbiology and cytopathologic results were reviewed. Data was analyzed for patient demographics, pulmonary lesion characteristics, the yield and complication rates of the procedure.

RESULTS: The mean age was 67 years. Slightly more than half (53%) were males. Most (77%) were smokers. 81% of the pulmonary lesions were >2 cm in size. The overall diagnostic yield of ENB was 81%, which is higher than published in the literature. ENB had a yield of 78% in the smaller peripheral lesions. More than half of the lesions (52%) were found to be malignant. Adenocarcinoma accounts for 40% of histologic cell types. Only 6(8%) patients had pneumothorax. Of the patients with pneumothorax, only 3 (4%) patients required insertion of a pleural catheter. The rate of pneumothorax did not vary with the size of the lesion. No major bleeding, hypoxia, respiratory failure, or death was reported.

CONCLUSIONS: In our study, we corroborated the highest yield and the lowest complication rate of electromagnetic navigational bronchoscopy for the diagnosis of peripheral pulmonary lesions which are beyond the reach of the conventional bronchoscopy. With evolving technology and further experience, electromagnetic navigational bronchoscopy will be the safest and the most effective method for the diagnosis of small peripheral pulmonary lesions.

CLINICAL IMPLICATIONS: This study reminds phisicians to avoid unnecessary subjection of patients to computed tomography (CT)-guided biopsy with higher risks of complications which ranges from 19 to 60% in the literature and lower yield of adequate tissue samples for histologic analysis.

DISCLOSURE: The following authors have nothing to disclose: Alehegn Gelaye, Karim Saleeby, Prabhat Sinha, Mohammed Farra

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