4D Electromagnetic Navigation Bronchoscopy for the Sampling of Pulmonary Lesions: First European Real-Life Experience

Filippo Patrucco,Francesco Gavelli,Zeno Falaschi,Renzo Luciano Boldorini,Matteo Daverio,Piero Emilio Balbo,Vittorio Longo,Chiara Airoldi

doi:10.1007/s00408-021-00477-z

Abstract

PurposeThe use of Electromagnetic navigation bronchoscopy (ENB) for the diagnosis of pulmonary peripheral lesions is still debated due to its variable diagnostic yield; a new 4D ENB system, acquiring inspiratory and expiratory computed tomography (CT) scans, overcomes respiratory motion and uses tracked sampling instruments, reaching higher diagnostic yields. We aimed at evaluating diagnostic yield and accuracy of a 4D ENB system in sampling pulmonary lesions and at describing their influencing factors.MethodsWe conducted a three-year retrospective observational study including all patients with pulmonary lesions who underwent 4D ENB with diagnostic purposes; all the factors potentially influencing diagnosis were recorded.Results103 ENB procedures were included; diagnostic yield and accuracy were, respectively, 55.3% and 66.3%. We reported a navigation success rate of 80.6% and a diagnosis with ENB was achieved in 68.3% of cases; sensitivity for malignancy was 61.8%. The majority of lesions had a bronchus sign on CT, but only the size of lesions influenced ENB diagnosis (p < 0.05). Transbronchial needle aspiration biopsy was the most used tool (93.2% of times) with the higher diagnostic rate (70.2%). We reported only one case of pneumothorax.ConclusionThe diagnostic performance of a 4D ENB system is lower than other previous navigation systems used in research settings. Several factors still influence the reachability of the lesion and therefore diagnostic yield. Patient selection, as well as the multimodality approach of the lesion, is strongly recommended to obtain higher diagnostic yield and accuracy, with a low rate of complications.

Highlights

The early detection and diagnosis of pulmonary lesions represents the cornerstone in lung cancer mortality reduction [1]
The variability of the Electromagnetic navigation bronchoscopy (ENB) diagnostic yield is influenced by many factors: some are dependent on the characteristics of lesions such as size, lobar location, 1 3 Vol.:(0123456789)
The primary aim of our study is to report the 4D SPiN® Thoracic Navigation System feasibility, diagnostic yield, accuracy and safety in approaching pulmonary lesions; the second aim is to evaluate factors that could influence the diagnostic performance of this navigation system

Summary

Introduction

The early detection and diagnosis of pulmonary lesions represents the cornerstone in lung cancer mortality reduction [1]. Electromagnetic navigation bronchoscopy (ENB) provides a multiplanar approach to lung lesions, leading the bronchoscope in close proximity for sampling procedures [2]. The navigation bronchoscopy system allows the bronchoscopist to better find the correct route to the target pulmonary lesion, compared to the conventional fluoroscopyguided bronchoscopy [3]. Many studies have been published on this subject, showing a pooled diagnostic yield of ENB between 65% and 74%, with a sensitivity of 77% [4,5,6]. A recent meta-analysis confirmed a higher diagnostic yield of navigation bronchoscopy systems for pulmonary nodules, 1.69 times higher than other non-navigation bronchoscopy ones [18, 19]

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