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Predictors of Success When Implementing an Electromagnetic Navigational Bronchoscopy Program

Published:February 22, 2022DOI:https://doi.org/10.1016/j.jss.2022.01.025

      Highlights

      • With electromagnetic navigational bronchoscopy, successful navigation can be improved with the presence of a bronchus sign, a nodule >2 cm, and distance from the pleura >1.4 cm.
      • A nodule size >1.3 cm with a positive bronchus sign led to the best probability of diagnostic biopsy.

      Abstract

      Introduction

      With the advent of lung cancer screening, lung nodules are being discovered at an increasing rate. With improvements in transbronchial biopsy technology, it is important for thoracic surgeons to be involved with diagnostic procedures. The aim of this project is to relate the thoracic surgeon experience in implementing an electromagnetic navigational bronchoscopy (ENB) program at our institution and describe the factors that led to successful navigation (the ability to position a biopsy instrument in range for biopsy) and diagnostic biopsy of nodules.

      Methods

      The thoracic surgery ENB program was initiated in 2014. A retrospective analysis of patients referred to thoracic surgery from 2014 to 2019 for lung nodule evaluation was performed. Patients who underwent ENB and biopsy were included. Recursive partitioning (CART) and multivariable regression analyses were used to identify predictors of successful navigation and biopsy.

      Results

      There were 73 patients who underwent ENB evaluation of 91 nodules from 2014 to 2019. There was successful navigation in 75.8% of nodules, and on multivariable analysis, bronchus sign, lesion size, and pleural distance were significant predictors of successful navigation. Of the lesions that had successful navigation, 65.2% had a diagnostic biopsy. Based on CART analysis, positive bronchus sign and lesion size ≥ 1.3 cm were most predictive of obtaining a diagnostic biopsy with a probability of 0.75.

      Conclusions

      Nodule size, distance to the pleura, and bronchus size are independent variables of successful navigation when using ENB. However, of the lesions that were successfully reached, combined lesion size >1.3 cm and a positive bronchus sign were most predictive of obtaining a diagnostic biopsy. These factors should be considered when implementing an ENB program in a thoracic surgery practice.

      Keywords

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      References

        • Cancer.org
        Lung cancer statistics | how common is lung cancer.
        (Available at:)
        • Church T.R.
        • Black W.C.
        • Aberle D.R.
        • et al.
        • National Lung Screening Trial Research Team
        Results of initial low-dose computed tomographic screening for lung cancer.
        N Engl J Med. 2013; 368: 1980-1991
        • MacMahon H.
        • Naidich D.P.
        • Goo J.M.
        • et al.
        Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017.
        Radiology. 2017; 284: 22
        • American College of Radiology Committee on Lung-RADS website
        Lung-RADS assessment categories version1.1.
        (Available at:)
        • Portela de Oliveira E.
        • Souza C.A.
        • Inacio J.R.
        • et al.
        Imaging-guided percutaneous biopsy of nodules ≤1 cm: study of diagnostic performance and risk factors associated with biopsy failure.
        J Thorac Imaging. 2020; 35: 123-128https://doi.org/10.1097/RTI.0000000000000427
        • Gould M.K.
        • Donington J.
        • Lynch W.R.
        • et al.
        Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2013; 143: e93S-e120Shttps://doi.org/10.1378/chest.12-2351
        • Ishiwata T.
        • Gregor A.
        • Inage T.
        • Yasufuku K.
        Bronchoscopic navigation and tissue diagnosis.
        Gen Thorac Cardiovasc Surg. 2020; 68: 672-678https://doi.org/10.1007/s11748-019-01241-0
        • Schreiber G.
        • McCrory D.C.
        Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence.
        Chest. 2003; 123: 115S-128S
        • Rivera M.P.
        • Mehta A.C.
        • Wahidi M.M.
        Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2013; 143: e142S-e165S
        • Weiser T.S.
        • Hyman K.
        • Yun J.
        • et al.
        Electromagnetic navigational bronchoscopy: a surgeon's perspective.
        Ann Thorac Surg. 2008; 85: S797-S801
        • Eberhardt R.
        • Kahn N.
        • Gompelmann D.
        • et al.
        LungPoint--a new approach to peripheral lesions.
        J Thorac Oncol. 2010; 5: 1559-1563
        • Loo F.L.
        • Halligan A.M.
        • Port J.L.
        • et al.
        The emerging technique of electromagnetic navigation bronchoscopy guided fine-needle aspiration of peripheral lung lesions: promising results in 50 lesions.
        Cancer Cytopathol. 2014; 122: 191-199
        • Lamprecht B.
        • Porsch P.
        • Wegleitner B.
        • et al.
        Electromagnetic navigation bronchoscopy (ENB): increasing diagnostic yield.
        Respir Med. 2012; 106: 710-715
        • Folch E.E.
        • Pritchett M.A.
        • Nead M.A.
        • et al.
        Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: one-year results of the prospective, multicenter NAVIGATE study.
        J Thorac Oncol. 2019; 14: 445-458
        • Stenger M.
        • Zoorob S.
        • Hussein A.A.
        • Eckardt J.
        Electromagnetic navigation bronchoscopy as an adjunct diagnostic tool in the Danish lung cancer diagnostic pathway: an initial retrospective single centre series.
        J Thorac Dis. 2020; 12: 4762-4770
        • Bhatt K.M.
        • Tandon Y.K.
        • Graham R.
        • et al.
        Bronchoscopy versus CT-guided percutaneous sampling of peripheral indeterminate pulmonary nodules: a cohort study.
        Radiology. 2018; 286: 1052-1061
        • Seijo L.M.
        • de Torres J.P.
        • Lozano M.D.
        • et al.
        Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study.
        Chest. 2010; 138: 1316-1321
        • Kalsi H.S.
        • Thakrar R.
        • Gosling A.F.
        • et al.
        Interventional pulmonology: a brave new world.
        Thorac Surg Clin. 2020; 30: 321-338