The Diagnostic Yield of Navigational Bronchoscopy Performed with Propofol Deep Sedation

Objective. To describe the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) utilizing propofol for procedural deep sedation. Methods. We conducted a structured retrospective analysis of the medical records of patients who underwent ENB with propofol for the evaluation of pulmonary nodules and masses. We analyzed the relationships between lesion size and location, variance (CT-to-body divergence), and positron emission tomography findings on diagnostic yield. Diagnoses were established by histopathological evaluation and clinical-radiographic followup. Results. 41 patients underwent ENB during the study period. The overall diagnostic yield was 89% (42 of 47 target lesions). Among the 42 positive specimens, the diagnoses were squamous cell carcinoma (n=10), adenocarcinoma (n=14), small cell carcinoma (n=2), adenocarcinoma in situ (n=2), coccidioidomycosis (n=1), and inflammatory processes (n=13). Average lesion size was 3.01±0.21 cm and variance 3.6±0.15 mm. The diagnostic yield was greater when the lesion size was >4 cm (100%) and when variance was ≤4 mm (91% versus 87%, P=0.003). Conclusion. The diagnostic yield of ENB utilizing propofol for procedural deep sedation at our center was excellent. ENB with deep sedation may result in superior diagnostic yield compared with ENB performed with moderate sedation.

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Diagnostic Performance of Electromagnetic Navigation Bronchoscopy-Guided Biopsy for Lung Nodules in the Era of Molecular Testing

Diagnostics ◽

10.3390/diagnostics11081432 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1432

Author(s):

Ju Hyun Oh ◽

Chang-Min Choi ◽

Seulgi Kim ◽

Se Jin Jang ◽

Sang Young Oh ◽

...

Keyword(s):

Safety Profile ◽

Diagnostic Yield ◽

Growth Factor Receptor ◽

Pulmonary Nodules ◽

Molecular Testing ◽

Nsclc Tissue ◽

Transthoracic Needle Biopsy ◽

Electromagnetic Navigation ◽

Anaplastic Lymphoma ◽

Guided Biopsy

Electromagnetic navigation bronchoscopy (ENB) is an emerging technique used to evaluate peripheral lung lesions. The aim of this study was to determine the diagnostic yield, safety profile, and adequacy of specimens obtained using ENB for molecular testing. This single-center, prospective pilot study recruited patients with peripheral pulmonary nodules that were not suitable for biopsy via percutaneous transthoracic needle biopsy methods. The possibility of molecular testing, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and programmed death ligand 1 (PD-L1), was identified with non-small cell lung cancer (NSCLC) tissue obtained using ENB. ENB-guided biopsy was performed on 30 pulmonary nodules in 30 patients. ENB-guided biopsy was successfully performed in 96.6% (29/30) of cases, but one case failed to approach the target lesion. The diagnostic accuracy of ENB-guided biopsy was 68.0% (17/25). Biopsy-related pneumothorax occurred in one patient and there was no major bleeding or deaths related to the procedure. Among 13 patients diagnosed with NSCLC, molecular testing was successfully performed in 92.3% (12/13). ENB-guided biopsy demonstrated acceptable accuracy and excellent sample adequacy, with a high possibility of achieving molecular testing and a good safety profile to evaluate peripheral pulmonary nodules, even when the percutaneous approach was difficult and/or dangerous.

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Diagnostic yield and safety of biopsy guided by electromagnetic navigation bronchoscopy for high‐risk pulmonary nodules

Thoracic Cancer ◽

10.1111/1759-7714.13930 ◽

2021 ◽

Author(s):

Ju Hyun Oh ◽

Chang‐Min Choi ◽

Seulgi Kim ◽

Woo Sung Kim ◽

Hee Sang Hwang ◽

...

Keyword(s):

High Risk ◽

Diagnostic Yield ◽

Pulmonary Nodules ◽

Electromagnetic Navigation

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Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions

European Respiratory Journal ◽

10.1183/13993003.00786-2015 ◽

2015 ◽

Vol 47 (2) ◽

pp. 607-614 ◽

Cited By ~ 21

Author(s):

Daniel P. Steinfort ◽

Asha Bonney ◽

Katharine See ◽

Louis B. Irving

Keyword(s):

Diagnostic Yield ◽

Lesion Size ◽

Endobronchial Ultrasound ◽

Virtual Bronchoscopy ◽

Cytologic Examination ◽

Electromagnetic Navigation ◽

Pulmonary Lesions ◽

Relative Contribution ◽

Peripheral Pulmonary Lesions ◽

Diagnosis Of Lung Cancer

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±10.5versus19.7±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.

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Diagnostic Yield of Combined Pulmonary Cryobiopsies and Electromagnetic Navigation in Small Pulmonary Nodules

Pulmonary Medicine ◽

10.1155/2018/6032974 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Olivier Taton ◽

Benjamin Bondue ◽

Pierre Alain Gevenois ◽

Myriam Remmelink ◽

Dimitri Leduc

Keyword(s):

Diagnostic Yield ◽

Pulmonary Nodules ◽

Electromagnetic Navigation ◽

Pet Ct ◽

Endobronchial Ultrasonography ◽

Risk Patients ◽

Peripheral Pulmonary Lesions ◽

Transbronchial Lung Cryobiopsy ◽

Fdg Pet Ct ◽

Small Pulmonary Nodules

Background. An increasing number of pulmonary nodules of unknown nature are detected as a result of screening by CT in high lung cancer risk patients. Objectives. The purposes of this study were to assess the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) combined with transbronchial lung cryobiopsy (TBLC) and to compare it with standard transbronchial biopsy (TBB) in pulmonary nodules of less than 2 cm in diameter. Methods. We prospectively included 32 patients (18 men and 14 women, mean age 68 ± 9 years) with nodules of less than 2 cm in diameter and no metastasis at 18FDG PET-CT. The nodule position was determined by ENB, radial endobronchial ultrasonography miniprobe, and fluoroscopy. Eight samples were obtained, six by TBB and two by TBLC. Results. Nodule diameter averaged 16 ± 3 mm. Twenty-five nodules were malignant and 18 were surgically resected. Surgery was avoided in four patients as the biopsies revealed a benign disease. The samples obtained by TBLC were five times larger than those by TBB. The diagnostic yields of TBLC and TBB were 69% and 38%, respectively (p=0.017). Adverse events consisted in 15 mild or moderate bleedings and one pneumothorax. Conclusions. In the setting of peripheral pulmonary lesions of less than 20 mm in diameter, ENB-combined TBLC is feasible and safe, provides larger samples, and has higher diagnostic yield than TBB.

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Evaluation Of The Diagnostic Value Of Electromagnetic Navigational Guided Targeted-Bronchoalveolar Lavage In The Diagnosis Of Lung Cancer

Pulmonary Medicine & Respiratory Research ◽

10.24966/pmrr-0177/100050 ◽

2020 ◽

Vol 6 (4) ◽

pp. 1-6

Author(s):

Ismael Matus ◽

Keyword(s):

Lung Cancer ◽

Diagnostic Yield ◽

Pulmonary Nodules ◽

Diagnostic Value ◽

Electromagnetic Navigation ◽

Diagnostic Bronchoscopy ◽

Tissue Acquisition ◽

Diagnosis Of Lung Cancer ◽

The Ideal

Electromagnetic Navigation Bronchoscopy (ENB) is recommended for the evaluation of Peripheral Pulmonary Nodules (PPNs). Current diagnostic bronchoscopy and pulmonary nodule evaluation guidelines do not establish recommendations regarding the role of individual tissue acquisition techniques, the ideal combination or sequence of executing them to optimize diagnostic yield.

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Minimally invasive interventions for pulmonary nodules biopsy. Systematic review protocol.

10.21203/rs.2.21738/v1 ◽

2020 ◽

Author(s):

Andre Miotto ◽

João Aléssio Juliano Perfeito ◽

Rafael Pacheco Leite ◽

Carolina de Oliveira Cruz Latorraca ◽

Rachel Riera

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Randomized Clinical Trials ◽

Diagnostic Yield ◽

Lung Nodule ◽

Pulmonary Nodules ◽

Percutaneous Biopsy ◽

Transbronchial Biopsy ◽

Endobronchial Ultrasound ◽

Electromagnetic Navigation

Abstract Background Lung cancer is the most common malignancy, causing more than 1.6 million deaths annually worldwide, including approximately 26.500 deaths in Brazil alone in 2015. The diagnosis of pulmonary nodules remains a challenge. Imaging tests are important for diagnostic suspicion and for estimating risk, but biopsy is necessary to confirm malignancy. Minimally invasive methods currently used include tomography-guided percutaneous biopsy (CTGB) and bronchoscopy transbronchial biopsy. The method of choice should have the best accuracy with the lowest possible complication rate. This systematic review was designed to map, critically evaluate and compare the effects (benefits and risks) of all lung nodule biopsy techniques. Methods We will conduct a systematic review accordantly to the Cochrane Handbook for Systematic Reviews of Interventions recommendations. Discussion This study aims to compare the diagnostic yield and the safety of different techniques used for pulmonary nodule biopsies. We will include randomized clinical trials comparing tomography-guided percutaneous biopsy, non-guided transbronchial biopsy, fluoroscopy-guided transbronchial biopsy, transbronchial biopsy guided by endobronchial ultrasound with radial probe and transbronchial biopsy guided by electromagnetic navigation. This study was approved by the research ethics committee of Universidade Federal de São Paulo (UNIFESP) with the number 1344040918. The results of the completed protocol will be presented at any appropriate conference by the authors.Systematic review registration The protocol for this review was prospectively registered in PROSPERO database (C RD42018092367).

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DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY IN SUBCENTIMETRIC PULMONARY NODULES

CHEST Journal ◽

10.1016/j.chest.2020.05.268 ◽

2020 ◽

Vol 157 (6) ◽

pp. A345

Author(s):

A. Izquierdo ◽

M. Morales García ◽

M.M. Choukri ◽

A. Giménez Velando ◽

J. Alfayate Sánchez ◽

...

Keyword(s):

Diagnostic Yield ◽

Pulmonary Nodules ◽

Electromagnetic Navigation

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Comparing Multimodality-Guided Transbronchial Lung Biopsy in Small Peripheral Pulmonary Nodules by Thin Bronchoscopy and Electromagnetic Navigation Bronchoscopy: A Randomised Trial

10.21203/rs.3.rs-102404/v1 ◽

2020 ◽

Author(s):

Supparerk Disayabutr ◽

Anuttra Ratnarathon ◽

Jamsak Tscheikuna

Keyword(s):

Multivariate Analysis ◽

Pulmonary Nodule ◽

Lung Biopsy ◽

Diagnostic Yield ◽

Randomised Trial ◽

Pulmonary Nodules ◽

Endobronchial Ultrasound ◽

Electromagnetic Navigation ◽

Significant Difference ◽

Mean Size

Abstract BackgroundVarious modalities of guided bronchoscopy have been developed to improve the diagnostic yield of peripheral pulmonary nodule (PPN). The present study compared the diagnostic yield between thin bronchoscopy (TB) and electromagnetic navigation bronchoscopy (ENB) in diagnosis of PPN.MethodsThe patients with PPN less than or equal to 30 mm were randomly assigned into 2 groups, 4-mm thin bronchoscope (TB group) and 5.9-mm conventional bronchoscope with using ENB (the superDimension) system (ENB group). In both groups, we used radial probe endobronchial ultrasound (R-EBUS) and fluoroscopy to guide transbronchial lung biopsy.ResultsThe total of 49 patients were enrolled and randomized into TB group (n=24) and ENB group (n=25). Mean size of PPN was 22 mm. There was no difference in nodule size, location of nodule, the presence of CT bronchus sign and EBUS visualization between groups. The diagnostic yields were 73.9% and 66.7% in TB group and ENB group, respectively. There was no statistically significant difference in the diagnostic yield between two groups and the non-inferiority of the TB group could not be confirmed. Multivariate analysis showed that the diagnostic yield was significantly higher if there is CT bronchus sign (odd ratio 48.82, p = 0.031) and the bronchoscope can reach more airway depth (odd ratio 6.21, p = 0.023). The overall complication was 2% which is pneumothorax in one patient in the TB group.ConclusionsThe thin bronchoscopy has a comparable diagnostic yield as electromagnetic bronchoscopy in diagnosis of peripheral pulmonary nodule without serious complication.Trial registrationTCTR, TCTR20200224003. Registered 24 February 2020 - Retrospectively registered, https://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=5834.

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