Electromagnetic Navigation Bronchoscopy: Where Are We Now? Five Years of a Single-Center Experience

Patrucco, Filippo; Gavelli, Francesco; Daverio, Matteo; Antonini, Cleto; Boldorini, Renzo; Casadio, Caterina; Balbo, Piero Emilio

doi:10.1007/s00408-018-0161-3

Cited by 34 publications

(24 citation statements)

References 35 publications

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“…Several studies investigating ENB's efficacy in diagnosing peripheral pulmonary nodules have reported variable diagnostic yields ranging from 69%-82.5%. 13,17 Although the diagnosis rate in this study was lower than that in previous studies, there are several considerations when interpreting these results. First, the type of sedation could affect ENB performance.…”

Section: Discussioncontrasting

confidence: 71%

“…The current study identified nodule size as an important factor associated with diagnostic yield. In previous investigations, the bronchus sign was also reported as a significant variable affecting the diagnostic yield 13,23 . This trend was observed in the univariate analysis but was irrelevant in the multivariate analysis in this study.…”

Section: Discussionsupporting

confidence: 65%

“…8,9 Electromagnetic navigation bronchoscopy (ENB) has recently been introduced to increase diagnostic yield while limiting complication risk. [10][11][12][13][14] However, the diagnostic yield and safety profile of ENB for high-risk pulmonary nodules that cannot be assessed by percutaneous methods are not well-researched. Most of the previous research reported the results of patients who underwent ENB procedures with general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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

Choi

Kim

et al. 2021

Thoracic Cancer

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Background Electromagnetic navigation bronchoscopy (ENB) is a useful method to obtain tissue for peripheral lung nodules. We aimed to understand the diagnostic yield and safety profile in high‐risk pulmonary nodules that cannot be accessed by percutaneous transthoracic needle biopsy. Methods In this single‐center retrospective study, we reviewed patients who underwent ENB for high‐risk pulmonary nodules. All procedures were performed under moderate sedation using intravenous midazolam and fentanyl. Results A total of 100 pulmonary nodules in 90 patients were subjected to ENB between October 2018 and May 2020. The median age of the study population was 66 (59–73). The mean diameter of the lung nodules was 27.9 mm. The diagnostic yield of ENB‐guided biopsy was 53.0%. Although the nodule size (odds ratio: 1.055, p = 0.007) and positive bronchus sign (odds ratio: 2.918, p = 0.020) were associated with the diagnostic yield during univariate analysis, nodule size was the only independent variable on the multivariable analysis. Interestingly, the diagnostic yield showed an upward trend after 60 cases, from 45%–65%. Procedure‐related complications were reported in 16 cases; among these, pneumothorax occurred in three cases, and four cases experienced moderate bleeding. No instance of major bleeding or death was linked to ENB‐guided biopsy. Conclusion ENB‐guided biopsy for high‐risk pulmonary nodules demonstrated an acceptable diagnostic yield and good safety profile. Moreover, the diagnostic yield was associated with nodule size and procedure experience.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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

Choi

Kim

et al. 2021

Thoracic Cancer

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“… 9 Use of needle aspiration in only 16% of AQuIRE subjects may have contributed to the overall low rate of ENB-aided diagnostic yield in that study. 34 The choice to put the aspirating needle in the restricted group may be questioned by those who consider this tool standard-of-care. However, multiple published papers have reported low use of the aspirating needle, even in expert centers.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Gildea

Folch

Khandhar³

et al. 2020

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is impacted by biopsy tool strategy and rapid on-site evaluation (ROSE) use. This analysis evaluates usage patterns, accuracy, and safety of tool strategy and ROSE in a multicenter study. Methods: NAVIGATE (NCT02410837) evaluates ENB using the superDimension navigation system (versions 6.3 to 7.1). The 1-year analysis included 1215 prospectively enrolled subjects at 29 United States sites. Included herein are 416 subjects who underwent ENB-aided biopsy of a single lung lesion positive for malignancy at 1 year. Use of a restricted number of tools (only biopsy forceps, standard cytology brush, and/or bronchoalveolar lavage) was compared with an extensive multimodal strategy (biopsy forceps, cytology brush, aspirating needle, triple needle cytology brush, needle-tipped cytology brush, core biopsy system, and bronchoalveolar lavage). Results: Of malignant cases, 86.8% (361/416) of true positive diagnoses were obtained using extensive multimodal strategies. ROSE was used in 300/416 cases. The finding of malignancy by ROSE reduced the total number of tools used. A malignant ROSE call was obtained in 71% (212/300), most (88.7%; 188/212) by the first tool used (49.5% with aspirating needle, 20.2% with cytology brush, 17.0% with forceps). True positive rates were highest for the biopsy forceps (86.9%) and aspirating needle (86.6%). Use of extensive tool strategies did not increase the rates of pneumothorax (5.5% restricted, 2.8% extensive) or bronchopulmonary hemorrhage (3.6% restricted, 1.1% extensive). Conclusion: These results suggest that extensive biopsy tool strategies, including the aspirating needle, may provide higher true positive rates for detecting lung cancer without increasing complications.

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“…At our center, we did not use transbronchial needle aspiration (TBNA). In a recent retrospective study by Patrucco et al, TBNA was used in combination with ROSE, prior to transbronchial forceps biopsies and bronchoalveolar lavage. Procedures were performed during general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic navigation bronchoscopy for lung nodule evaluation. Patient selection, diagnostic variables and safety

Andersen

Degn

Rasmussen

2020

Clinical Respiratory J

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Background Electromagnetic navigation bronchoscopy (ENB) is a relatively new technique to diagnose pulmonary lesions in patients with reduced lung function. Several parameters have been shown to affect diagnostic yield including patient selection. We performed a prospective registration of data on one hundred patients who consecutively underwent electromagnetic navigation bronchoscopy. Selection criteria, patient characteristics, lesion size, distance to pleura, location of the lesion and presence of bronchus sign on computed tomography were registered. Methods Navigation was performed using the superDimension hardware and software system. Patients were referred to ENB from a multidisciplinary team conference. We did not use fluoroscopy, endobronchial ultrasound equipment, rapid onsite evaluation or general anesthesia during the procedure. All patients in whom no malignant diagnose was found were subsequently followed for two years in order to verify a benign nature of the pulmonary lesion. Results One hundred and nine ENB procedures were performed between September 2009 and November 2014. Overall diagnostic yield was 68%. Twenty seven of 49 malignant tumors were found by ENB leading to a sensitivity for malignancy of 55%. The sensitivity for malignancy was significantly higher for lesions in the upper and middle lobes compared to the lower lobes (P = 0.01). Lesions size, distance to pleura and presence of bronchus sign did not affect sensitivity. Conclusion ENB is a safe diagnostic procedure in an everyday setting with an acceptable diagnostic yield even without addition of supportive diagnostic methods and offers a possibility to diagnose pulmonary nodules in patients for whom other diagnostic procedures are too hazardous or have proven unsuccessful.

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Electromagnetic Navigation Bronchoscopy: Where Are We Now? Five Years of a Single-Center Experience

Abstract: ENB is a safe procedure with a similar diagnostic yield in the real-life and research setting. Bronchus sign is an important factor in determining the diagnostic yield. ENB efficacy can be maximized by expertise and by a careful selection of each case.

Cited by 34 publications

References 35 publications

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

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

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective

Electromagnetic navigation bronchoscopy for lung nodule evaluation. Patient selection, diagnostic variables and safety

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