Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules

Chee, Alex; Stather, David R.; MacEachern, Paul; Martel, Simon; Delage, Antoine; Simon, Mathieu; Dumoulin, Elaine; Tremblay, Alain

doi:10.1111/resp.12085

Cited by 39 publications

(47 citation statements)

References 23 publications

(35 reference statements)

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“…This is consistent with the only previously published study examining performance of EMN in patients in whom radial EBUS had failed to localise the lesion. CHEE et al [11] observed an improvement in visualisation from 75% to 93% with addition of EMN, but were only able to improve diagnostic yield by 7%, consistent with our findings. While EMN is a navigation tool, EBUS may be considered a localisation tool with visualisation of target PPLs confirming sampling is being performed from the exact site of interest.…”

Section: Discussionsupporting

confidence: 82%

“…Isolated reports suggest combining the two techniques may achieve the highest diagnostic yields [7], although given EBUS achieves a sensitivity of 73% [2], and exceeding 84% in some reports [8][9][10], the cumulative gain seen following addition of EMN may not justify routine use of EMN consumables. Only one study has reported use of EMN only if peripheral lesions were unable to be localised with EBUS [11]. In that study, CHEE et al [11] described outcomes in 60 patients with a significant improvement in localisation rates, but no improvement in diagnostic yield.…”

Section: Introductionmentioning

confidence: 96%

“…Only one study has reported use of EMN only if peripheral lesions were unable to be localised with EBUS [11]. In that study, CHEE et al [11] described outcomes in 60 patients with a significant improvement in localisation rates, but no improvement in diagnostic yield.…”

Section: Introductionmentioning

confidence: 96%

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Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±SD). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5 versus 19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL-hilum distance or PPL-pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63-76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield. @ERSpublications EMN after nondiagnostic radial EBUS gives only small incremental gain in visualisation rate and diagnostic yield

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 96%

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Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

et al. 2015

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“…This image-guided localization device could reportedly reach the peripheral lung lesions and obtain biopsy tissues (6,7). Thus far, however, the results, and ramifications of the benefits of ENB are still under debate (8). The accuracy and efficiency of ENB in the diagnosis of SPPLs has not been investigated in Asian populations.…”

Section: Introductionmentioning

confidence: 99%

The introduction of electromagnetic navigation bronchoscopy for the diagnosis of small pulmonary peripheral lesions in an Asian population

Gu¹,

Chen²,

Shi³

et al. 2017

J. Thorac. Dis.

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Background: Electromagnetic navigation bronchoscopy (ENB) is emerging as a useful new technique fordiagnosing small pulmonary peripheral lesions (SPPLs). However, the accuracy and efficiency of ENB have not been investigated in Asian populations where the differential diagnoses for SPPLs may be different. To analyze this question, this study included patients who received diagnostic ENB followed by surgery for the excision of SPPLs.Methods: Consecutive patients referred to the Department of Thoracic Surgery, Shanghai Pulmonary Hospital (Tongji University), between May 2014 and April 2015 were recruited. ENB was used to obtain biopsy tissue and make a diagnosis, which was then confirmed by histopathological examination. Results:The ENB was performed on 84 SPPLs of 78 patients in the study, with four patients having more than one SPPL. It successfully reached and biopsied 81 lesions. The average ENB navigation time was The distance from the sensor probe to the focus was 8.0 mm (range, 1-16 mm). ENB diagnosis had identical results with histopathology examination in 81 lesions (37 lung cancer and 41 non-lung cancer). The sensitivity of ENB was 92.9% (78 out of 84 lesions) in this study.Conclusions: These data suggested that ENB was an accurate and efficient procedure to sample and diagnose SPPLs in the Asian population. It appeared that ENB had a high percentage of successful results in both navigating and aiding in the diagnosis of SPPLs in the Asian population.

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“…In this vein of how to continually improve our use of advanced bronchoscopic imaging, in this issue of Respirology, Chee et al 9 performed a prospective study aimed at predicting the factors associated with the need for combining pEBUS and NB and to determine what factors are associated with the 'gap' between localization and diagnosis of PPN. They were able to show that the majority of lesions were localizable using only the pEBUS, but that NB did improve this ability.…”

mentioning

confidence: 99%

Bridging the gap between localization and diagnosis of peripheral pulmonary nodules

Akulian

2013

Respirology

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Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules

Abstract: ENB improves localization of lung lesions after unsuccessful pEBUS but is often not sufficient to ensure confirmation of a specific diagnosis. Technical improvements in sampling methods could improve the diagnostic yield.

Cited by 39 publications

References 23 publications

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

The introduction of electromagnetic navigation bronchoscopy for the diagnosis of small pulmonary peripheral lesions in an Asian population

Bridging the gap between localization and diagnosis of peripheral pulmonary nodules

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