Yield Of Electromagnetic Navigation Bronchoscopy Research Articles

High diagnostic yield of electromagnetic navigation bronchoscopy performed under cone beam CT guidance: results of a randomized Belgian monocentric study

BackgroundWith the increasing use of low dose CT scans, numerous pulmonary nodules are detected. As majority of them are benign, development of efficient non-surgical diagnostic intervention is mandatory. Electromagnetic navigation bronchoscopy (ENB) has been developed to reach difficult to access lesions. The aim of the present study was to compare the diagnostic yield of ENB procedures performed in a classical endoscopy suite or in a hybrid room equipped by a cone beam CT (CBCT).MethodsA monocentric randomized study was performed in the Erasme Hospital between January 2020 and December 2021. Lung nodules of maximum 30 mm of diameter were eligible. In both arms (endoscopy or CBCT suites), ENB, fluoroscopic guidance and a radial endobronchial ultrasound were used to reach the lesion. Then six trans-bronchial biopsies (TBB) and one trans-bronchial lung cryobiopsy (TBLC) were performed. Primary outcomes were the diagnostic yield and diagnostic accuracy of the procedure.ResultsForty-nine patients were randomized (24 in the endoscopy and 25 in the CBCT arms). The lesion size was 15,9 ± 4,6 mm and 16,6 ± 6,0 mm respectively (mean ± SD, p = NS). The diagnostic yield of ENB performed under CBCT guidance was 80% compared to 42% when performed in the endoscopy suite under standard fluoroscopic guidance (p < 0,05). Similarly, the diagnostic accuracy in the CBCT group was 87% compared to 54% for the endoscopy group (p < 0,05). Duration of the procedure in the CBCT and endoscopy arms was 80 ± 23 and 61 ± 13 min respectively (mean ± SD, p < 0,01). Performing TBLC in addition to TBB increased the diagnostic yield by 14% (17 and 12,5% in CBCT and endoscopy suites respectively, p = NS).ConclusionThis study highlighted the additional value to perform ENB procedure under CBCT guidance for small size (less than 2 cm of diameter) pulmonary nodules.Trial registrationClinical trial registration number: NCT05257382.

FACTORS AFFECTING THE DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY IN BIOPSY OF PERIPHERAL PULMONARY NODULES IN A COMMUNITY HOSPITAL

FACTORS AFFECTING THE DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY IN BIOPSY OF PERIPHERAL PULMONARY NODULES IN A COMMUNITY HOSPITAL

Does the addition of radial endobronchial ultrasound improve the diagnostic yield of electromagnetic navigation bronchoscopy? A systematic review

Does the addition of radial endobronchial ultrasound improve the diagnostic yield of electromagnetic navigation bronchoscopy? A systematic review

The Impact of Biopsy Tool Choice and Rapid On-Site Evaluation on Diagnostic Accuracy for Malignant Lesions in the Prospective: Multicenter NAVIGATE Study.

Background:The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is impacted by biopsy tool strategy and rapid on-site evaluation (ROSE) use. This analysis evaluates usage patterns, accuracy, and safety of tool strategy and ROSE in a multicenter study.Methods:NAVIGATE (NCT02410837) evaluates ENB using the superDimension navigation system (versions 6.3 to 7.1). The 1-year analysis included 1215 prospectively enrolled subjects at 29 United States sites. Included herein are 416 subjects who underwent ENB-aided biopsy of a single lung lesion positive for malignancy at 1 year. Use of a restricted number of tools (only biopsy forceps, standard cytology brush, and/or bronchoalveolar lavage) was compared with an extensive multimodal strategy (biopsy forceps, cytology brush, aspirating needle, triple needle cytology brush, needle-tipped cytology brush, core biopsy system, and bronchoalveolar lavage).Results:Of malignant cases, 86.8% (361/416) of true positive diagnoses were obtained using extensive multimodal strategies. ROSE was used in 300/416 cases. The finding of malignancy by ROSE reduced the total number of tools used. A malignant ROSE call was obtained in 71% (212/300), most (88.7%; 188/212) by the first tool used (49.5% with aspirating needle, 20.2% with cytology brush, 17.0% with forceps). True positive rates were highest for the biopsy forceps (86.9%) and aspirating needle (86.6%). Use of extensive tool strategies did not increase the rates of pneumothorax (5.5% restricted, 2.8% extensive) or bronchopulmonary hemorrhage (3.6% restricted, 1.1% extensive).Conclusion:These results suggest that extensive biopsy tool strategies, including the aspirating needle, may provide higher true positive rates for detecting lung cancer without increasing complications.

Improved diagnostic yield for lung nodules with digital tomosynthesis-corrected navigational bronchoscopy: Initial experience with a novel adjunct.

The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is inferior to that of computed tomography (CT)-guided needle biopsy for pulmonary nodules. One explanation for this is divergence between the nodule location on the pre-procedure CT scan and its actual location during the procedure. Fluoroscopic ENB (F-ENB) consists of digital tomosynthesis using a conventional C-arm to re-register the target lesion based on near real-time imaging. We performed a retrospective review of ENB cases at our institution before and after introduction of F-ENB to assess diagnostic yield. All consecutive ENB procedures performed at our institution from 25 December 2017 to 25 August 2018 were reviewed. F-ENB was introduced on 25 April 2018. Two cohorts were analysed: standard ENB (S-ENB) from 25 December 2017 to 24 April 2018 and F-ENB from 25 April 2018 to 25 August 2018. All procedural, demographic and diagnostic data were collected. Descriptive statistics, chi-square, Wilcoxon test and Student's t-test were used where appropriate. A multivariable regression analysis was performed to assess factors associated with diagnostic yield. A total of 101 and 67 nodules were biopsied in the S-ENB and F-ENB groups, respectively. Diagnostic yield was 54% in S-ENB cohort and 79% in the F-ENB group (P = 0.0019). Factors independently associated with a positive diagnosis were F-ENB and a positive radial ultrasound view (odds ratio (OR): 3.57, 95% CI: 1.56-8.18 and OR: 3.74, 95% CI: 1.37-11.05, respectively). Complications were minimal (pneumothorax: 1.5%). The use of F-ENB may increase the diagnostic yield of ENB and has a low complication rate.

Diagnostic Yield of Electromagnetic Navigation Bronchoscopy Using a Curved-tip Catheter to Aid in the Diagnosis of Pulmonary Lesions.

Background:Electromagnetic navigation bronchoscopy (ENB) may aid in the diagnosis of solitary pulmonary lesions with a lower complication rate than conventional diagnostic modalities. A curved-tip catheter is now available for use with ENB; however, the diagnostic yield of this device has not been previously reported.Methods:A single-center, single-operator retrospective chart review was performed on patients who underwent ENB for the diagnosis of pulmonary lesions. A curved-tip catheter was used in all procedures; angle options were chosen depending on lesion location. After navigation to the target lesion, fine-needle aspiration, brushings, biopsies, and bronchoalveolar lavage were performed in all patients. Correct localization was confirmed with fluoroscopy.Results:Thirty-one consecutive patients underwent ENB between February and October 2014. The mean lesion size was 1.8 cm (range, 0.4 to 4.0 cm) and 35% were in the right upper lobe. The probe tip was navigated to the target lesion in all cases. A diagnosis was obtained in 30/31 patients (96.8%). Twenty-two (71%) had a definitive histologic diagnosis of malignancy. One case was nondiagnostic requiring a repeat fine-needle aspiration. The remaining 8 nonmalignant cases were followed radiologically and demonstrated no progression of lesion size through at least 1 year. Fiducials were placed in 48% of cases. There were 2 pneumothoraces (6.5%), one of which required chest tube placement (3.2%).Conclusions:This study suggests that the curved-tip catheter is a useful modality for diagnosing peripheral pulmonary lesions with ENB. The diagnostic yield of ENB using this catheter was superior to that reported in other studies utilizing straight catheters.

The emerging technique of electromagnetic navigation bronchoscopy‐guided fine‐needle aspiration of peripheral lung lesions: Promising results in 50 lesions

Literature on the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) with ENB-guided fine-needle aspiration (ENB-FNA) in peripheral lung lesions (PLLs) that measure ≤ 2 cm is scarce. Data on the diagnostic yield of ENB-FNA for PLLs when performed in conjunction with positron emission tomography-computed tomography (PET-CT), rapid on-site evaluation (ROSE), ENB-guided bronchial brushing (ENB-BB), and ENB-guided transbronchial biopsy (ENB-TBx) is also limited. In this study, the authors evaluated their experience with ENB-FNA performed in conjunction with all 4 modalities: PET-CT, ROSE, ENB-BB, and ENB-TBx. ENB-FNA and other tests over a 2-year-period (from July 2011 to July 2013) were retrospectively reviewed. There were 50 PLLs from 40 patients, and the mean lesion size (available for 45 PLLs) was 2.6 cm: these included 24 PLLs that measured ≤ 2 cm and 21 PLLs that measured > 2.0 cm. The ENB-FNA diagnosis was malignant in 17 lesions, atypical in 1 lesion, benign in 31 lesions, and nondiagnostic in 1 lesion. On the basis of lesion size, the diagnostic yield of PLLs was 87% in lesions ≤ 2 cm and 100% in lesions > 2.0 cm (P = 0.5; not significant). Follow-up available in 49 of 50 PLLs from 39 patients had an overall diagnostic yield of 94% for ENB-FNA. The diagnostic yield of PET-CT (available in 31 of 50 PLLs) and of ENB-BB and ENB-TBx (available in 40 of 50 PLLs) in conjunction with ENB-FNA was 61% and 95%, respectively. ROSE was performed in 46 of 50 PLLs: the overall sensitivity of ROSE and ENB-FNA was 85% and 89.4%, respectively, and their specificity was 96.5% and 100%, respectively. There were no procedure-related complications. The high overall diagnostic yield of 94% and fewer complications make ENB-FNA a useful modality for the assessment of PLLs. In this study, ROSE was useful, whereas PET-CT, ENB-BB, and ENB-TBx were not useful in the evaluation of PLLs.

The Diagnostic Yield of Navigational Bronchoscopy Performed with Propofol Deep Sedation

Objective. To describe the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) utilizing propofol for procedural deep sedation. Methods. We conducted a structured retrospective analysis of the medical records of patients who underwent ENB with propofol for the evaluation of pulmonary nodules and masses. We analyzed the relationships between lesion size and location, variance (CT-to-body divergence), and positron emission tomography findings on diagnostic yield. Diagnoses were established by histopathological evaluation and clinical-radiographic followup. Results. 41 patients underwent ENB during the study period. The overall diagnostic yield was 89% (42 of 47 target lesions). Among the 42 positive specimens, the diagnoses were squamous cell carcinoma (n=10), adenocarcinoma (n=14), small cell carcinoma (n=2), adenocarcinoma in situ (n=2), coccidioidomycosis (n=1), and inflammatory processes (n=13). Average lesion size was 3.01±0.21 cm and variance 3.6±0.15 mm. The diagnostic yield was greater when the lesion size was &gt;4 cm (100%) and when variance was ≤4 mm (91% versus 87%, P=0.003). Conclusion. The diagnostic yield of ENB utilizing propofol for procedural deep sedation at our center was excellent. ENB with deep sedation may result in superior diagnostic yield compared with ENB performed with moderate sedation.

Multicenter Experience With Electromagnetic Navigation Bronchoscopy for the Diagnosis of Pulmonary Nodules

Physicians are increasingly encountering lung nodules in their practice, and tissue diagnosis is often required. Conventional bronchoscopic sampling yields a range from 14% to 69% depending on the nodule size and location within the lung. We aimed to evaluate the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) in multiple centers and to determine what factors affect the yield of ENB. A retrospective analysis of 92 consecutive ENB procedures at 5 centers was carried out. Data were collected on patient demographics, nodule characteristics, complications, type of samples obtained, diagnosis, and follow-up studies. Variables were analyzed to determine as to which factors had an impact on the diagnostic yield with multiple logistic regression analysis. Ninety-two patients underwent EMB at 5 centers between December 2008 and October 2009. The average nodule size was 2.61 cm (SD 1.42) at a distance of 1.81 cm (SD 1.32) from the pleural surface. The overall yield for ENB-guided sampling of pulmonary nodules was 65% (60/92). The ENB yield for nodules ≤2 versus >2 cm in size was significantly less after controlling for the distance from the pleura (50% vs. 76%, respectively; P=0.01). The distance from the pleura did not affect the ENB diagnostic yield after controlling for nodule size (P=0.92). The lobar location of the nodule also did not affect the diagnostic yield (P=0.59). The diagnostic yield of ENB-guided sampling of pulmonary nodules is impacted by the nodule size, but not by the distance from the pleura or the lobar location.

The Presence of a Bronchus Sign and Tissue Sampling Tools Significantly Influences the Yield of Electromagnetic Navigation Bronchoscopy

PURPOSE: To evaluate the utility of using more than one tool to obtain diagnostic specimens when performing electromagnetic navigation bronchoscopy (ENB) and the value of the presence of a bronchus sign.

Diagnostic Yield of Electromagnetic Navigation Bronchoscopy Is Highly Dependent on the Presence of a Bronchus Sign on CT Imaging: Results From a Prospective Study

Electromagnetic navigation bronchoscopy (ENB) has been developed as a novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules. Despite successful navigation in 90% of patients, ENB diagnostic yield does not generally exceed 70%. We sought to determine whether the presence of a bronchus sign on CT imaging conditions diagnostic yield of ENB and might account for the discrepancy between successful navigation and diagnostic yield.We conducted a prospective, single-center study of ENB in 51 consecutive patients with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique in patients with a high surgical risk, suspected metastatic disease, or advanced-stage disease, or in those who demanded a preoperative diagnosis prior to undergoing curative resection. We studied patient and technical variables that might condition diagnostic yield, including size, cause, location, distance to the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the presence of a bronchus sign on CT imaging; registration point divergence; and the minimum distance from the tip of the locatable guide to the nodule measured during the procedure.The diagnostic yield of ENB was 67% (34/51). The sensitivity and specificity of ENB for malignancy in this study were 71% and 100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign. Univariate analysis identified the bronchus sign (P = .005) and nodule size (P = .04) as statistically significant variables conditioning yield, but on multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95% CI, 1.8-31.7). No procedure-related complications were observed.ENB diagnostic yield is highly dependent on the presence of a bronchus sign on CT imaging.

Multicenter Experience With Electromagnetic Navigation Bronchoscopy for the Diagnosis of Pulmonary Nodules

BACKGROUND Physicians are increasingly encountering lung nodules in their practice, and tissue diagnosis is often required. Conventional bronchoscopic sampling yields a range from 14% to 69% depending on the nodule size and location within the lung. We aimed to evaluate the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) in multiple centers and to determine what factors affect the yield of ENB. METHODS A retrospective analysis of 92 consecutive ENB procedures at 5 centers was carried out. Data were collected on patient demographics, nodule characteristics, complications, type of samples obtained, diagnosis, and follow-up studies. Variables were analyzed to determine as to which factors had an impact on the diagnostic yield with multiple logistic regression analysis. RESULTS Ninety-two patients underwent EMB at 5 centers between December 2008 and October 2009. The average nodule size was 2.61 cm (SD 1.42) at a distance of 1.81 cm (SD 1.32) from the pleural surface. The overall yield for ENB-guided sampling of pulmonary nodules was 65% (60/92). The ENB yield for nodules ≤2 versus >2 cm in size was significantly less after controlling for the distance from the pleura (50% vs. 76%, respectively; P=0.01). The distance from the pleura did not affect the ENB diagnostic yield after controlling for nodule size (P=0.92). The lobar location of the nodule also did not affect the diagnostic yield (P=0.59). CONCLUSIONS The diagnostic yield of ENB-guided sampling of pulmonary nodules is impacted by the nodule size, but not by the distance from the pleura or the lobar location.

ELECTROMAGNETIC NAVIGATIONAL BRONCHOSCOPY: AN EFFECTIVE AND SAFE APPROACH TO DIAGNOSING PERIPHERAL LUNG LESIONS UNREACHABLE BY CONVENTIONAL BRONCHOSCOPY

PURPOSE: To investigate the diagnostic yield of electromagnetic navigation bronchoscopy and its associated complications in peripheral lung lesions deemed otherwise unapproachable using conventional bronchoscopy.

BIOPSY INSTRUMENT AND YIELD IN ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY

PURPOSE: Electromagnetic Navigation Bronchoscopy (ENB) increases yield for pulmonary nodules. Variable yields in the literature maybe due differences in technique unrelated to ENB. Most report transbronchial biopsies (TBBx) but others have used multiple sampling techniques. This study assesses Cytology brush (CB) and TBBx on the yield of electromagnetic navigation bronchoscopy.