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Observational Study
. 2021 Oct;199(5):493-500.
doi: 10.1007/s00408-021-00477-z. Epub 2021 Sep 25.

4D Electromagnetic Navigation Bronchoscopy for the Sampling of Pulmonary Lesions: First European Real-Life Experience

Filippo Patrucco  1   2 , Matteo Daverio  3 , Chiara Airoldi  4 , Zeno Falaschi  5 , Vittorio Longo  5 , Francesco Gavelli  4 , Renzo Luciano Boldorini  6 , Piero Emilio Balbo  3
Affiliations
Observational Study

4D Electromagnetic Navigation Bronchoscopy for the Sampling of Pulmonary Lesions: First European Real-Life Experience

Filippo Patrucco et al. Lung. 2021 Oct.

Abstract

Purpose: The use of Electromagnetic navigation bronchoscopy (ENB) for the diagnosis of pulmonary peripheral lesions is still debated due to its variable diagnostic yield; a new 4D ENB system, acquiring inspiratory and expiratory computed tomography (CT) scans, overcomes respiratory motion and uses tracked sampling instruments, reaching higher diagnostic yields. We aimed at evaluating diagnostic yield and accuracy of a 4D ENB system in sampling pulmonary lesions and at describing their influencing factors.

Methods: We conducted a three-year retrospective observational study including all patients with pulmonary lesions who underwent 4D ENB with diagnostic purposes; all the factors potentially influencing diagnosis were recorded.

Results: 103 ENB procedures were included; diagnostic yield and accuracy were, respectively, 55.3% and 66.3%. We reported a navigation success rate of 80.6% and a diagnosis with ENB was achieved in 68.3% of cases; sensitivity for malignancy was 61.8%. The majority of lesions had a bronchus sign on CT, but only the size of lesions influenced ENB diagnosis (p < 0.05). Transbronchial needle aspiration biopsy was the most used tool (93.2% of times) with the higher diagnostic rate (70.2%). We reported only one case of pneumothorax.

Conclusion: The diagnostic performance of a 4D ENB system is lower than other previous navigation systems used in research settings. Several factors still influence the reachability of the lesion and therefore diagnostic yield. Patient selection, as well as the multimodality approach of the lesion, is strongly recommended to obtain higher diagnostic yield and accuracy, with a low rate of complications.

Keywords: Bronchus Sign; Electromagnetic Navigation Bronchoscopy; Lung Cancer Diagnosis; Navigation System; Pulmonary Masses; Pulmonary Nodule.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Multiplanar Computed Tomography images (upper images), 3D images of the real-time sampling with transbronchial needle aspiration (lower images)
See this image and copyright information in PMC

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