Role of Computed Tomography-guided Biopsies in the Era of Electromagnetic Navigational Bronchoscopy: A Retrospective Study of Factors Predicting Diagnostic Yield in Electromagnetic Navigational Bronchoscopy and Computed Tomography Biopsies

Abstract

Objectives: Over 25% of the high-risk population screened for lung cancer have an abnormal computed tomography (CT) scan. Conventionally, these lesions have been biopsied with CT guidance with a high diagnostic yield. Electromagnetic navigational bronchoscopy (ENB) with transbronchial biopsy has emerged as a technology that improves the diagnostic sensitivity of conventional bronchoscopic biopsy. It has been used to biopsy lung lesions, due to the low risk of pneumothorax. It is, however, a new technology that is expensive and its role in the diagnosis of the solitary pulmonary nodule (SPN) is yet to be determined. The purpose of this study was to evaluate the diagnostic yield of CT-guided biopsy (CTB) following non-diagnostic ENB biopsy and identify characteristics of the lesion that predicts a low diagnostic yield with ENB, to ensure appropriate use of ENB in the evaluation of SPN. Materials and Methods: One hundred and thirty-five lung lesions were biopsied with ENB from January 2017 to August 2019. Biopsies were considered diagnostic if pathology confirmed malignancy or inflammation in the appropriate clinical and imaging setting. We evaluated lesions for several characteristics including size, lobe, and central/peripheral distribution. The diagnostic yield of CTB in patients who failed ENB biopsies was also evaluated. Logistic regression was used to identify factors likely to predict a non-diagnostic ENB biopsy. Result: Overall, ENB biopsies were performed in 135 patients with solitary lung lesions. ENB biopsies were diagnostic in 52% (70/135) of the patients. In 23 patients with solitary lung lesions, CTBs were performed following a non-diagnostic ENB biopsy. The CTBs were diagnostic in 87% of the patients (20/23). ENB biopsies of lesions <21.5 mm were non-diagnostic in 71% of cases (42/59); 14 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% of them were diagnostic (12/14). ENB biopsies of lesions in the lower lobes were non- diagnostic in 59% of cases (35/59); 12 of these patients with non-diagnostic ENB biopsies had CTBs, and 83% were diagnostic (10/12). ENB biopsies of lesions in the outer 2/3 were non-diagnostic in 57% of cases (50/87); 21 of these patients with non-diagnostic ENB biopsies had CTBs, and 86% were diagnostic (18/21). Conclusion: CTBs have a high diagnostic yield even following non-diagnostic ENB biopsies. Lesions <21.5 mm, in the outer 2/3 of the lung, and in the lower lung have the lowest likelihood of a diagnostic yield with ENB biopsies. Although CTBs have a slightly higher pneumothorax rate, these lesions would be more successfully diagnosed with CTB as opposed to ENB biopsy, in the process expediting the diagnosis and saving valuable medical resources.

Outcomes of the electromagnetic navigation bronchoscopy using forceps for lung lesion suspected malignancy: A retrospective study

“…Therefore, ENB may be an effective diagnostic tool for lung lesions. The rate of pneumothorax complications was low (1.4%), similar to a previous study that reported 2.0% to 2.1% [12,16] to 10%. [17] Multivariable analysis revealed that a larger lesion size on CT and the presence of CT-BS were significant factors associated with pathological confirmation.…”

Current Endovascular Treatment Options in Acute Pulmonary Embolism

“…Most recent guidelines, from various chest and cardiac societies, recommend the addition of ST to standard AC for massive PE. [ 11 , 26 - 28 ] However, the recommendations for the use of adjunct procedures/treatments in sub-massive PE are less specific. The guidelines or expert consensus do not address the use of advanced endovascular treatment options or the clinical circumstances in which they may be appropriate.…”

Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the “core” of the Problem? A Retrospective Case–control Study

“…[ 23 - 26 ] Post-renal biopsy hemorrhage is likely the result of multiple factors including the intrinsic renal vascularity, the non-compressible location of the kidneys, the need for multiple needle passes to ensure an adequate tissue sample, and medical comorbidities such as obesity, liver dysfunction, and diabetes. [ 27 - 29 ] Post-biopsy bleeding can be further categorized into major and minor hemorrhage, with major hemorrhage requiring additional interventions, such as blood transfusion, endovascular intervention, or nephrectomy. [ 30 , 31 ]…”