Electromagnetic Navigation Bronchoscopy Performed by Thoracic Surgeons: One Center's Early Success

Abstract

Multiple studies by pulmonologists have demonstrated that electromagnetic navigation bronchoscopy (ENB) can, with high diagnostic yields and low complication rates, diagnose pulmonary lesions. We believe thoracic surgeons can perform this technique with excellent early results. A retrospective analysis was conducted of the first consecutive 104 patients undergoing diagnostic ENB by 2 thoracic surgeons between April 2008 and October 2009. Procedures utilized general anesthesia and rapid on-site examination (ROSE) of cytopathology. All pulmonary lesions were suspicious for malignancy. Patients having negative biopsies subsequently underwent additional procedures or follow-up imaging. True negative biopsies were defined as lesions removed surgically and proven benign, lesions that disappeared on subsequent imaging, and lesions demonstrating stability over a 2-year period. Of 104 patients, 3 were excluded due to insufficient follow-up. The remaining 101 patients had a median lesion size of 2.8 cm. Sixty-seven (82%) of the 82 lesions that were determined malignant had a positive diagnosis upon ENB. Of the 34 lesions without a positive ENB biopsy, 19 (56%) were categorized as true negatives: 8 had benign surgical biopsies, 6 disappeared, and 5 demonstrated stability. Consequently, 86 of 101 cases had an accurate ENB biopsy for a diagnostic yield of 85%. There was insufficient evidence to demonstrate an association between lesion size and diagnostic accuracy. There were 6 pneumothoraces (5.8%). It is possible for thoracic surgeons to perform ENB with early success. The high diagnostic yields in this study may be attributed to the routine utilization of ROSE and general anesthesia, which preserves computed tomographic-to-body divergence.