Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study

Abstract

Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P < .001). Age, American Society of Anesthesiologists class, emphysema grade, nodule size, and distance from pleura were not significant predictors of increased diagnostic yield. Intraprocedural time for physicians was significantly lower with CT-guided sampling (P < .001). Similar yield for molecular analyses was noted with the two approaches (ENB-guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. RSNA, 2017 Online supplemental material is available for this article.

Combination of Percutaneous Lung Biopsy and Xpert MTB/RIF Ultra Enhances the Differential Diagnosis of Tuberculosis: A Prospective Cohort Study

“…However, we must trade off between the gain and disadvantage of biopsy sampling. Percutaneous lung biopsy is an invasive examination and often accompanies local pain and percutaneous emphysema, and sometimes it can cause local inflammation as well [19]. The expenditure and inaccessibility of biopsy under CT scan guidance limit its usage for patients who need it desperately.…”

Current Novel Advances in Bronchoscopy

“…Sufficient yield for molecular analysis was similar between both modalities (89 vs. 82%, respectively). Complication rates were significantly higher complications in transthoracic biopsies compared to CT guided biopsy with increased incidence of pneumothorax (29 vs. 4%) and bleeding (17 vs. 3.3%), though thoracostomy tube placement and significant bleeding rates were similarly low (13). While ultimate interventions and major complications remained low, the higher rate of bleeding and pneumothorax requires admission and observation to ensure serious sequelae do not develop.…”

Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies

“…CT-guided biopsy of pulmonary nodules has become a standard procedure for tissue sampling. Compared to navigational bronchoscopy with biopsy, percutaneous CT-guided biopsies are less expensive and have a higher diagnostic yield in the assessment of peripheral pulmonary nodules 2,3 . Compared to surgery, percutaneous CTguided lung biopsies are less invasive and reduce the amount of anaesthesia required.…”