Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 1;28(4):255-261.
doi: 10.1097/LBR.0000000000000766.

Diagnostic Yield of Digital Tomosynthesis-assisted Navigational Bronchoscopy for Indeterminate Lung Nodules

James Katsis  1 , Lance Roller  1 , Matthew Aboudara  1 , Jasleen Pannu  2 , Heidi Chen  3 , Joyce Johnson  4 , Robert J Lentz  1 , Otis Rickman  1 , Fabien Maldonado  1
Affiliations

Diagnostic Yield of Digital Tomosynthesis-assisted Navigational Bronchoscopy for Indeterminate Lung Nodules

James Katsis et al. J Bronchology Interv Pulmonol. .

Abstract

Background: Navigational bronchoscopy is commonly used to sample lung nodules, with a better safety profile but lower diagnostic yield than computerized tomography-guided transthoracic needle biopsy. The addition of digital tomosynthesis to electromagnetic navigation, using intraprocedural images obtained from a C-arm fluoroscope to identify target lesion location and update navigational guidance, may improve diagnostic yield.

Methods: Consecutive bronchoscopies using tomosynthesis-assisted fluoroscopic electromagnetic navigational bronchoscopy (F-ENB) at a single institution over a 1-year period were included. The primary outcome was diagnostic yield. A bronchoscopy was defined as diagnostic if pathologic examination revealed malignancy or specific histological findings indicative of lesional sampling with confirmatory 6-month follow-up for benign lesions.

Results: A total of 324 patients with 363 nodules underwent F-ENB between April 25, 2018 and April 29, 2019. The average nodule size was 1.9±1.1 cm, 65% of the nodules were located in the peripheral third of the lung. A bronchus sign was present in 24% of cases. Of the 363 nodules, 299 (82.4%) had lesional findings. At 6-month follow-up, among these 299 nodules, 6 were found to be false negatives and 12 nodules were lost to follow-up. Considering all nodules lost to follow-up as false negatives, the 6-month diagnostic yield was 77.4%. Pneumothorax complicated 8 (2.5%) of cases. There was 1 episode of respiratory failure.

Conclusion: This retrospective study suggests the diagnostic yield of F-ENB may exceed that of traditional ENB. Future prospective and comparative studies are needed to confirm these promising data.

PubMed Disclaimer

Conflict of interest statement

Disclosure: F.M. reports consulting fees and research support from Medtronic. O.R. reports consulting fees from Medtronic. For the remaining authors there is no conflict of interest or other disclosures.

Comment in

  • Fluoroscopy: Vintage Car, the Opportunity Knocks.
    Xia Y, Li Q, Yarmus L, Wang K. Xia Y, et al. J Bronchology Interv Pulmonol. 2023 Jan 1;30(1):87-89. doi: 10.1097/LBR.0000000000000857. J Bronchology Interv Pulmonol. 2023. PMID: 36597200 No abstract available.

References

    1. Gould MK, Tang T, Liu ILA, et al. Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med. 2015;192:1208–1214.
    1. US National Institute Of Health, National Cancer Institute. SEER Cancer Statistics Review, 1975-2015. Available at: https://seer.cancer.gov/ . Accessed April 8, 2020.
    1. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2005;365:2481–2488.
    1. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382:503–513.
    1. Dibardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. J Thorac Dis. 2015;7:304–316.