Navigational Bronchoscopy for Early Lung Cancer: A Road to Therapy

Abstract

Peripheral lung nodules remain challenging for accurate localization and diagnosis. Once identified, there are many strategies for diagnosis with heterogeneous risk benefit analysis. Traditional strategies such as conventional bronchoscopy have poor performance in locating and acquiring the required tissue. Similarly, while computerized-assisted transthoracic needle biopsy is currently the favored diagnostic procedure, it is associated with complications such as pneumothorax and hemorrhage. Video-assisted thoracoscopic and open surgical biopsies are invasive, require general anesthesia and are therefore not a first-line approach. New techniques such as ultrathin bronchoscopy and image-based guidance technologies are evolving to improve the diagnosis of peripheral lung lesions. Virtual bronchoscopy and electromagnetic navigation systems are novel technologies based on assisted-computerized tomography images that guide the bronchoscopist toward the target peripheral lesion. This article provides a comprehensive review of these emerging technologies.

The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta‐analysis

“…Endobronchial ultrasound (EBUS) confirms the arrival of biopsy instruments on site . Navigation bronchoscopy, including virtual bronchoscopic navigation (VBN), electromagnetic navigation (ENB) and other navigation instruments, facilitates PPL diagnosis by directing a bronchoscope to its intended target via visualized three‐dimensional lung models . All have been reported to increase diagnostic yield .…”

Prevention and Early Detection for NSCLC: Advances in Thoracic Oncology 2018

“…The overall performance of VB in a recent literature review was reported to be 73.8%, reduced to 67.4% for lesions less than or equal to 2 cm. 129 Electromagnetic navigation bronchoscopy (ENB) is an image-based technology that uses VB and facilitates approaching peripheral lung lesions by means of electromagnetic fields. 130 There are two commercially available systems that provide ENB: i-Logi (Covidien, Minneapolis, Minnesota) and SPiNDrive (Veran Medical Technologies, Inc., St. Louis, Missouri).…”

Scientific Advances in Thoracic Oncology 2016

“…To meet the clinical demand, new methods have been developed. Electromagnetic navigation bronchoscopy using assisted CT allows precise targeting of peripheral nodules, 40 whereas transbronchial cryobiopsy is a promising tool to obtain large and high-quality specimens. 41 Several studies have reported that cytologic specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration or fine-needle aspiration are equally suitable for molecular testing.…”