Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions

Abstract

Background and Objectives:Electromagnetic navigation bronchoscopy (ENB) is a promising new technology to increase the diagnostic yield of peripheral lung and mediastinal lesions. Conventional flexible bronchoscopy has a limited yield in peripheral pulmonary lesions, even in experienced hands. Radial endobronchial ultrasound (r-EBUS) with its real-time imaging capability can help to diagnose peripheral pulmonary lesions. In the present study, we aimed to investigate the diagnostic yield and safety of ENB with or without r-EBUS for peripheral lung lesions.Materials and Methods:This study was conducted in a tertiary medical center, and 56 consecutive patients who were thought to be the best candidates for bronchoscopic biopsies at a multidisciplinary meeting were enrolled. ENB was performed under conscious sedation by using an electromagnetic tracking system with multiplanar reconstruction of previously acquired computed tomography (CT) data. Sampling was performed by biopsy forceps, endobronchial brush, and bronchoalveolar lavage.Results:Fifty-six patients (50 men and 6 women; mean age, 60 ± 9 years) were studied. While an electromagnetic navigation system was used in all patients, r-EBUS was used in 26 of 56 patients. The median diameter of the lesions was 30 mm (interquartile range: 23-44 mm). Mean distance of the lesions from the pleura was 14.9 ± 14.6 mm. Mean procedure time was 20 ± 11.5 min. Mean registration error was 5.8 ± 1.5 mm. Mean navigation error was 1.2 ± 0.5 mm. The diagnostic yield of the procedure was 71.4% for peripheral lesions (non-small cell lung cancer = 23, small cell lung cancer = 3, benign diseases = 14). Pneumothorax occurred in only 1 patient (1.7%).Conclusion:ENB with or without r-EBUS is a safe, efficient, and easily applied method for sampling of peripheral lung lesions, with high diagnostic yield independent of lesion size and location.

Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study

“…The median duration of the procedure was 57 min overall and 31 min for the ENB procedure, similar to the overall NAVIGATE study (52 min and 25 min, respectively) 22 and ENB literature reports ranging from 20 to 70 min. 31,32 Procedure times were even shorter in those patients with only FM placement and no lung lesion biopsy. Additionally, ENB guidance was aided by cone–beam CT in 4% and rEBUS in 37%.…”

Electromagnetic Navigation Bronchoscopy Combined Endobronchial Ultrasound in the Diagnosis of Lung Nodules

“…Very few studies analyzing the correlation between the density of lesion and diagnostic yield. [ 20 ] A recent prospective multicenter clinical study showed that the diagnostic yield of ENB was 72.9% and the false negative rate was 45.4% after 1-year follow-up completed. [ 21 ] However, in this high credibility study only 6.3% of the enrolled cases were SSNs, and the diagnostic yield subgroup analysis of SN and SSN were not performed.…”

Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

“…In addition to R-EBUS, promising techniques for interventional bronchoscopy of peripheral lung lesions include ENB27 and VB728. The reported diagnostic performance was 74% with ENB4 and about 80% with VB2930 and the combination of these modalities achieved success rate of 80%–81% (R-EBUS and VB)531 and 63%–73% (R-EBUS and ENB)3233. There was no clear indication for these tools, thus the comparisons and combinations to establish proper use are still required.…”