4D electromagnetic navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules - An overview and preliminary clinical results

Abstract

The diagnostic of peripheral pulmonary nodules (PPN) is a particular challenge in interventional bronchology, which is why navigation systems such as electromagnetic navigation (ENB) are increasingly being used. The 4D-ENB represents the most current development of the ENB. It utilizes inspiratory and expiratory CT scans for mapping and thus helps compensate for respiratory movements-induced CT-to-body divergence. The aim of this work was to present the first clinical data and experiences using the 4D-ENB method for diagnosis of PPNs. We retrospectively describe the results of the first nine consecutive patient cases diagnosed at Klinikum Braunschweig using 4D-ENB in a unimodal diagnostic procedure. Of the first 9 PPNs examined by 4D-ENB, navigation and puncture of the lesion was successful in 8 patients (89%). Diagnostic biopsy was could be carried out in six out of nine patients (67%). There were no significant procedure-related complications. Our preliminary data suggest that 4D-ENB is a promising new alternative for the diagnosis of PPNs. To further improve diagnostic yield, 4D-END, which lacks real-time visualization, should be embedded in a multimodal diagnostic procedure with rEBUS and/or fluoroscopy.