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

Abstract

Lung cancer is one of the most common causes of cancer death in the US. Screening for lung cancer has therefore become imperative as early detection has shown to improve survival. Low dose computed tomography (CT) imaging of the chest is an important tool to help identify nodules in the screened population. Once a nodule is identified, there are several ways to obtain a diagnosis, with the technique dependent on the location and size of the nodule. About 500,000 bronchoscopies are performed annually in the US in the goal of nodule diagnosis but 65% of these fails to reach peripheral lesions. This results in a diagnostic yield of around 14% for peripheral lesions less than 2 cm in size. This yield is lower than that of CT-guided biopsy. A variety of new technologies and tools have been developed to improve bronchoscopic tissue diagnosis for solitary pulmonary nodules (SPN), but continue to have limited success in the setting of peripheral and small pulmonary nodules. This review will focus on electromagnetic navigational (EMN) guided percutaneous transthoracic lung biopsy for peripheral small lung nodules not amenable to navigational bronchoscopy by non-interventional radiology providers.