COMPARISON OF DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY-GUIDED TRANSBRONCHIAL FORCEPS BIOPSY TO TRANSBRONCHIAL NEEDLE ASPIRATION IN THE DIAGNOSIS OF PERIPHERAL PULMONARY LESIONS

Abstract

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The use of electromagnetic navigation as an adjunct to flexible bronchoscopy in the diagnosis of pulmonary lesions has been shown to improve yield. In this study, we compared the diagnostic yield of concurrently performed transbronchial needle aspiration (TBNA) and transbronchial forceps biopsy (TBFB) in patients undergoing electromagnetic navigation-guided bronchoscopy (ENB) for diagnosis of peripheral pulmonary lesions. METHODS: A retrospective study was conducted on all patients who underwent concurrent ENB-guided transbronchial needle aspirations and transbronchial forceps biopsies at Ochsner LSU Health Shreveport, LA between July 2018 to December 2019. RESULTS: 86 ENB procedures were performed on 82 patients (mean age 62 years; 35 females, 47 males); four patients needed repeat procedures for new pulmonary lesions or for prior negative studies. 72 (88%) patients had a history of nicotine use and 37 (45%) had a history of malignancy. Of 86 procedures done, samples were inadequate or non-diagnostic in 6 cases, while 9 cases were lost to follow up, and as such final diagnoses of the lung lesions could not be confirmed. Of the remaining 71 procedures, ENB was diagnostic in 53 cases (75%; 42 malignant, 11 non-malignant) and was falsely negative in 18 cases (25%; 16 malignant and 2 non-malignant). False negatives were diagnosed with CT-guided biopsy or at lobectomy. Overall, the sensitivity of concurrent ENB-guided TBNA with TBFB in the diagnosis of malignant and benign peripheral pulmonary lesions was 72% (p = 0.03). Of 58 total malignant cases, transbronchial needle aspiration (TBNA) positively compared to transbronchial forceps biopsy (TBFB) with 39/58 vs 32/58 (sensitivity 67.2% vs 55.2%; p = 0.0001). Sensitivity for diagnosis of malignant lesions increased to 72.4% (P < 0.0001) when both methods were combined. Of the 13 nonmalignant cases, TBFB gave a definite diagnosis in 10/13 vs 8/13 for TBNA (sensitivity 60% vs 30%; p = > 0.05). Using both methods, sensitivity increased to 70% (p = 0.0699). There were no significant complications. The average follow up period was from 3 months to 2 years; patients followed up for less than 6 months showed improvement or resolution of symptoms and or image findings on follow up. CONCLUSIONS: While TBNA alone appeared to have a better performance than TBFB alone in the diagnosis of malignant pulmonary lesions during ENB, the combination of both methods significantly increased diagnostic yield for both malignant and non-malignant lesions. Thus, more widespread use of both instruments during ENB, and even during simple endobronchial bronchoscopies, could increase the sensitivities of both procedures. CLINICAL IMPLICATIONS: To the best our knowledge, this is the first study comparing diagnostic yield of concurrently performed transbronchial needle aspiration (TBNA) and transbronchial forceps biopsy (TBFB) at electromagnetic navigation guided bronchoscopy. DISCLOSURES: No relevant relationships by Olaedo Abana, source=Web Response No relevant relationships by UZAIR Ghori, source=Web Response Site Investigator for EMPROVE relationship with Olympus-Spiration Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support Site Investigator for DAS 181 relationship with Ansun pharmaceutical Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support No relevant relationships by Rusella Mirza, source=Web Response No relevant relationships by Derek Rainwater, source=Web Response