Cardiothoracic Surgery: Cardiothoracic Surgery |

Electromagnetic Navigational Bronchoscopy for Non-small Cell Lung Cancer: Clinical and Radiographic Factors Predicting Successful Diagnosis FREE TO VIEW

Juan Munoz, MD; Hiran Fernando, MBBS; Sowmya Rao, PhD; Michael Ebright, MD; Virginia Litle, MD
Author and Funding Information

Boston University School of Medicine, Boston, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):34A. doi:10.1016/j.chest.2016.08.041
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SESSION TITLE: Cardiothoracic Surgery

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Electromagnetic Navigational Bronchoscopy (ENB) is increasingly used to evaluate lung nodules suspicious for NSCLC. Reported success ranges from 59-80%. We sought to identify clinical and radiographic criteria that would optimize cancer diagnostic yield.

METHODS: A retrospective review of patients undergoing diagnostic ENB was conducted. Between September 2012 and March 2016, 100 ENBs were performed in 95 patients for the evaluation of lung nodules. If a diagnosis was not achieved after ENB, a CT-guided biopsy or surgical resection was performed. Only patients with a confirmed non-small cell lung cancer (NSCLC) diagnosis were included in this analysis. Clinical factors, lesion location and size and presence of a bronchus sign were evaluated for their impact on achieving a successful diagnosis. Bivariate analysis was performed using two-sided chi-square tests.

RESULTS: Overall, 66/100 patients had a NSCLC diagnosis, and 53% (36/66) of the cases were correctly identified by ENB. Larger lesion size (≥ 3cm), presence of bronchus sign and location within the upper and middle lobes were significantly associated with a successful NSCLC diagnosis (p<0.05). Cancers located in a central/intermediate location and BMI <24.9Kg/m2 had trends favoring cancer diagnosis.

CONCLUSIONS: Larger tumors associated with a bronchus sign and within the upper or middle lobes were more likely to be diagnosed by ENB. Peripheral tumors and being overweight may impact success and this will need to be investigated in larger studies. Consideration of these variables may guide physicians in selecting ENB or CT-guided biopsy when evaluating lung nodules.

CLINICAL IMPLICATIONS: The optimal clinical and radiographic guidelines for obtaining a diagnosis with navigational bronchoscopy biopsies are not known. This study addresses potential variables that may optimize diagnostic yield.

DISCLOSURE: The following authors have nothing to disclose: Juan Munoz, Hiran Fernando, Sowmya Rao, Michael Ebright, Virginia Litle

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