Implementation of Electromagnetic Navigation Bronchoscopy (ENB) in a Medico-Surgical Department. Results after 6 months of experience

Abstract

Background: Electromagnetic navigation bronchoscopy (ENB) is an emerging technique in Europe, allowing peripheral lung nodules biopsies, with a sensitivity of 70-80 % in the literature. Aim and objective In June 2016, ENB was acquired by our institution. We analyzed the results of our initial 6-month experience. Methods: We recorded the size of the lesion, the SUVmax on PET-CT, and the presence of the bronchus sign (BS) – a visible bronchus leading directly to the lesion on CT scan. ENB was performed under general anaesthesia. Results: ENB was performed in 21 patients (16 men, 5 women; mean age 67 yrs). The mean size of lesion was 25.8 mm (14-65), mean SUVmax 9.1 (1.7- 22) and mean duration of ENB was 45 min (25-100). In 10 (48%) patients, ENB diagnosed lung cancer or recurrence (n=9), and metastasis (n=1). ENB was negative in 11 (52 %) patients, including our first 5 procedures (learning curve effect). In 7 of 11 ENB-negative cases, a final diagnosis of lung cancer (n=6) or metastasis (n=1) was achieved by other means. Follow-up ruled out cancer in 2 ENB-negative patients, and the final diagnosis remained uncertain for the 2 last patients. After comparison between positive and negative ENBs, only the presence of BS was associated with a positive diagnostic procedure (p=0.04). In the 19 patients with a definite diagnosis, ENB sensitivity was 58.8% (95%CI: 36-78%), specificity 100%, and negative predictive value 22%. Conclusion: After 6 months of ENB, we almost reached the sensitivity reported in literature. ENB-negative patients need to be investigated by other diagnostic means.