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

Abstract

Electromagnetic navigational bronchoscopy (ENB) combined with a radial endobronchial ultrasound probe realizes a combination of magnetic navigation and ultrasound imaging, allowing for the accurate navigation of peripheral lung lesions in real time during surgery. ENB has been evaluated in many studies. However, a comparative report on the feasibility of ENB combined radial endobronchial ultrasound diagnosis in different density lung nodules was small, and few of these studies have reported long-term follow-up results to exclude false negative results. The aim of this study is to explore the applicability of ENB combined radial endobronchial ultrasound in the diagnosis of lung nodules with different densities. Patients underwent biopsy in our medical center from 2016-09 to 2019-03 were divided into 2 groups: the solid nodule group and the subsolid pulmonary nodule group. We collected and analyzed the diagnostic accuracy, the diagnostic yield, the false negative rate and the incidence of complications between these 2 groups. A total of 37 lesions in 25 patients were biopsied, 14 lesions were subsolid pulmonary nodules and 23 were solid nodules. The diagnostic accuracy (success rate to obtain meaningful pathology tissues) was 34/37 (91.8%). Lost to follow-up in 1 case and three cases were undiagnosed. After at least 12 months of follow-up, the total diagnostic yield (true positive rate+ true negative rate) was 27/36 (75%) (P = .006). The false negative rate was 9/19 (47.3%) (P = .26). Complications occurred in 1/36 (2.7%) lesions. For the subsolid pulmonary nodule group, the diagnostic accuracy was 13/14 (92.8%) and the diagnostic yield was 7/14 (50%). For the solid nodule group, the diagnostic accuracy was 21/23 (91.3%), and the diagnostic yield was 20/22 (90.9%). Electromagnetic navigational bronchoscopy combined with radial endobronchial ultrasound in peripheral lung nodule biopsies is safe and effective, especially for solid nodules, but the diagnostic yield in subsolid nodule biopsies remains to be improved.

Electromagnetic navigational percutaneous transthoracic needle lung biopsy for peripheral small lung nodules not amenable to navigational bronchoscopy

“…When this was combined with EBUS, the diagnostic yield was 92%. This study showed that it is acceptable, safe, and feasible to combine these procedures (6,11,12). Another study showed similar results with diagnostic yields for patients undergoing percutaneous biopsy being 90% and when combined with EMN was 92%; an increase in diagnostic yield by 20% when adding percutaneous needle biopsy has also been shown (17,18).…”

Advances in Diagnostic Bronchoscopy

“…A prospective randomized controlled trial reported that the combined use of RP-EBUS along with ENB has better diagnostic yield of 88% compared to either technology alone [131]. A single-center retrospective study also demonstrated that ENB combined with RP-EBUS biopsy for the diagnosis of PPLs was safe and effective [132].…”

Inheritance and innovation of the diagnosis of peripheral pulmonary lesions

“…Recently, researchers have recognized the fact that ENB requires the support of X-ray fluoroscopy, CBCT or EBUS for adjustment before biopsy to achieve a higher diagnostic rate. 70,[104][105][106][107][108] One-year data from a prospective, multicenter, global cohort study (NAVIGATE study) found that the diagnostic rate of ENB combined with pre-biopsy adjustment can reach 73%. 109 Studies have shown that PPLs with diameter ⩾2 cm and located in the upper lobe or middle lobe are important univariate predictors.…”