Sensitivity and Safety of Electromagnetic Navigation Bronchoscopy for Lung Cancer Diagnosis

Folch, Erik; Labarca, Gonzalo; Ospina-Delgado, Daniel; Kheir, Fayez; Majid, Adnan; Khandhar, Sandeep J.; Mehta, Hiren J.; Jantz, Michael A.; Fernández-Bussy, Sebastián

doi:10.1016/j.chest.2020.05.534

Cited by 130 publications

(114 citation statements)

References 62 publications

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“…A recent meta-analysis involving 40 studies including the NAVIGATE trial showed that ENB had an overall sensitivity of 77% for the detection of malignancy. [ 24 ] The sensitivity for the detection of malignancy was slightly lower in our study, but as the authors point out in a meta-analysis which included the NAVIGATE study, the sensitivity was positively associated with lung cancer prevalence (66% in their meta-analyses), which was lower in our cohort (48.6%). Two other meta-analyses done all report a diagnostic yield for any diagnosis between 70% and 74%.…”

Section: Discussioncontrasting

confidence: 58%

Diagnostic yield of electromagnetic navigational bronchoscopy

Cherian

Kaur

Karanth

et al. 2021

Annals of Thoracic Medicine

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INTRODUCTION: Electromagnetic navigational bronchoscopy (ENB) is an excellent tool to diagnose peripheral pulmonary nodules, especially in the setting of emphysema and pulmonary fibrosis. However, most of these procedures are done by interventional pulmonologists and academic tertiary centers under general anesthesia. Studies evaluating the diagnostic utility of this tool in safety-net community hospitals by pulmonologists not formally trained in this technology are lacking. The objective was to evaluate the diagnostic yield of ENB done in such a setting and its associated complications. METHODS: Retrospective chart review of consecutive ENB procedures over 5 years from 2014, since its inception in our institution-a safety-net community based hospital was performed. Multiple variables were analyzed to assess their impact on diagnostic yields. RESULTS: After exclusion criteria were applied, 72 patients with 76 procedures were eventually included within our study, with an overall 1-year diagnostic yield of 80.2%. Sensitivity for malignancy was 73% and negative predictive value of 65%. Primary lung cancer was the most common diagnosis obtained, followed by tuberculosis (TB). The overall complication rates were low, with only 1 patient (1.3%) requiring hospitalization due to pneumothorax needing tube thoracostomy. No deaths or respiratory failures were noted within the cohort. The only significant variable affecting diagnostic yield was forced expiratory volume in 1 s. The presence of emphysema did not affect diagnostic yield. CONCLUSIONS: ENB is safe and feasible with a high diagnostic success rate even when performed by pulmonologists not formally trained in interventional pulmonology in low resource settings under moderate sedation.

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Section: Discussioncontrasting

confidence: 58%

Diagnostic yield of electromagnetic navigational bronchoscopy

Cherian

Kaur

Karanth

et al. 2021

Annals of Thoracic Medicine

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“…A recent meta-analysis of 40 studies of electromagnetic navigation bronchoscopy, including the use of RP-EBUS, reported a pooled sensitivity for malignancy of 77% and a 2% risk for pneumothorax. 1 Robotic-assisted bronchoscopy was developed to address limitations of conventional guided bronchoscopy. Early data indicate enhanced ability of those platforms to reach and sample lung nodules.…”

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confidence: 99%

Multiplanar 3D fluoroscopy redefines tool–lesion relationship during robotic‐assisted bronchoscopy

et al. 2020

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Guided bronchoscopy platforms have rapidly evolved over the past two decades to allow high-yield tissue acquisition of suspicious peripheral pulmonary nodules. 1 Robotic-assisted bronchoscopy platforms aim to overcome limitations of conventional guided bronchoscopy by allowing for precision access to smaller and more peripheral lesions. 2 The Ion Robotic-Assisted Endoluminal Platform (Intuitive Surgical, Sunnyvale, CA, USA) features a console-controlled catheter with an outer diameter of 3.5 mm and a 2.0-mm working channel. Localization within the airway tree is based on a shape-sensing fibre embedded along the catheter's length and navigation is based on a computed tomography (CT)-generated virtual road map. 2 Following navigation, adjunctive imaging techniques are used to confirm approximation to the lesion. Conventional modalities include radial probe endobronchial ultrasound (RP-EBUS) and 2D fluoroscopy. Cios-Spin (Siemens Healthineers, Forchheim, Germany) is a mobile 2D-3D C-arm that produces intraoperative 1952 × 1952 pixel images over an area of 295 × 295 mm 2. 3 Multiplanar 3D imaging is obtained

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“…We typically perform transbronchial needle aspiration, brush biopsies, forceps biopsies, and bronchoalveolar lavage independently of the system used as this practice has shown improved diagnostic yield. 2,8 Once the procedure is done, the patient is extubated and transferred to the recovery room. A chest x-ray is obtained to rule out pneumothorax or other acute complications and if negative the patient is discharged home.…”

Section: How To Do Itmentioning

confidence: 99%

“…Conventional diagnostic approaches such as computed tomography (CT) guided biopsy have shown good results, with a reported sensitivity of over 90%; however, location (>1 cm from pleural surface or location within the lower lobes) and lesion size (<2 cm in diameter) can affect diagnostic yield. 2,3 Additionally, CT-guided biopsy can be complicated by hemorrhage and pneumothorax, the latter reported in as many as 30% of cases. [4][5][6] Novel techniques such as electromagnetic navigational bronchoscopy (ENB) have emerged in an attempt to improve accessibility to certain nodules and diagnostic yield.…”

Section: Introductionmentioning

confidence: 99%