Procedures: Procedures 1 - EMN/BT/Rigid/Cryo |

Diagnostic Accuracy and Complication Rates After Implementation of an Electromagnetic Navigation Bronchoscopy Program at an Academic Teaching Hospital FREE TO VIEW

Deepinder Osahan, MD; Malay Aparnath, MD; Anish Desai, MD; Daniel Kurbanov, MD; Steve Salzman, MD; Shalinee Chawla, MD; Peter Spiegler, MD; Joseph Mathew, MD
Author and Funding Information

Winthrop-University Hospital, Mineola, NY

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

Chest. 2016;150(4_S):1006A. doi:10.1016/j.chest.2016.08.1112
Text Size: A A A
Published online

SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo

SESSION TYPE: Original Investigation Poster

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

PURPOSE: Electromagnetic navigation bronchoscopy (ENB) is a procedure which combines computed tomography (CT) generated virtual bronchoscopy with electromagnetic tracking to enable passage of a steerable probe beyond the distal airways. Recent studies have established the diagnostic sensitivity of ENB around 60-80%. When compared to trans-thoracic needle aspiration (TTNA), the incidence of pneumothorax is much lower (<5%), thus making ENB an attractive alternative. We performed a retrospective analysis of pre-existing data at our institution on patients undergoing ENB with trans-bronchial needle aspiration (TBNA) between August 2013 and October 2015 and sought to identify patient and nodule characteristics to improve diagnostic accuracy.

METHODS: ENB’s were performed using Covidien’s LungGPSTM technology and the superDimensionTM navigation system with the EdgeTM catheter by two pulmonologists. Radial endoscopic bronchial ultrasound (EBUS), fluoroscopy and rapid on-site evaluation (ROSE) were used to improve diagnostic yield. A total of 60 patients were included in the final analysis. Data regarding patient demographics, cytology results, subsequent imaging and follow up, nodule characteristics and complication rates was recorded.

RESULTS: 57 patients underwent ENB for workup of a pulmonary nodule or mass. Two patients had ENB performed for fiducial marker placement, and one for dye marking of a nodule prior to surgery. 61% of biopsies involved nodules in the upper lobes. 65% (n=26) of the nodules were between one and three centimeters in size. The overall diagnostic yield of ENB using radial EBUS and fluoroscopy was 68.4%. ENB with TBNA confirmed malignancy in 46% (n=26) of the total patients. Four individual cases of non-malignant etiologies were also confirmed by TBNA. Of the 54% (n=31) of cases which were negative by ENB, 38.7% (n=12) were confirmed to be malignant by subsequent CT guided or surgical biopsy. Two patients died and five were lost to follow up. The overall sensitivity of ENB was 68.4%, with a NPV of 47.8%. After looking at the location of the nodule, ENB had a 70.8% sensitivity and a 46.1% NPV for upper lobe lesions, and a 62.5% sensitivity and 33.3% NPV for lower lobe lesions. The first 30 patients undergoing ENB had a diagnostic sensitivity of 57.7%, which increased to 81.3% for the next 30 patients (p=0.05821). One patient was diagnosed with pneumothorax post procedure which resolved with conservative treatment.

CONCLUSIONS: The diagnostic accuracy of ENB observed at our hospital is slightly less than previously reported. Factors such as patient selection and learning curve should be taken into account whenever a new diagnostic modality is implemented at an institution. However, there is a suggestion that upper lobe lesions may be more amenable to ENB than lower lobe lesions. Interestingly, our diagnostic yield was higher when ENB was combined with radial EBUS compared to data from the AQuIRE registry.

CLINICAL IMPLICATIONS: ENB should be the diagnostic modality of choice for peripheral lung lesions, especially in patients with a high risk of pneumothorax.

DISCLOSURE: The following authors have nothing to disclose: Deepinder Osahan, Malay Aparnath, Anish Desai, Daniel Kurbanov, Steve Salzman, Shalinee Chawla, Peter Spiegler, Joseph Mathew

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543