TY - JOUR
T1 - Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions
AU - Eberhardt, Ralf
AU - Anantham, Devanand
AU - Herth, Felix
AU - Feller-Kopman, David
AU - Ernst, Armin
N1 - Funding Information:
The locatable sensor probes at both Thoraxklinik and Beth Israel Deaconess Medical Center were provided free of charge by superDimension/Bronchus. superDimension/Bronchus has supported CME courses at the Thoraxklinik Heidelberg and Harvard University through unrestricted educational grants. Dr. Ernst was a member of the Scientific Advisory Board of superDimension/Bronchus and had been reimbursed for time and travel expenses related to that function. Dr. Ernst also had stock options, which have been returned in the past. Dr. Ernst was not involved in the consenting process of patients. Drs. Eberhardt, Anantham, Herth, and Feller-Kopman have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
PY - 2007/6
Y1 - 2007/6
N2 - Background: Electromagnetic navigation bronchoscopy (ENB) with biopsy under fluoroscopic guidance has enhanced the yield of flexible bronchoscopy in the diagnosis of peripheral lung lesions. However, the accuracy of ENB navigation suggests that the addition of fluoroscopy is redundant. Objectives: Data were prospectively collected to determine the yield of ENB without fluoroscopy in the diagnosis of peripheral lung lesions. Method: ENB was performed via flexible bronchoscopy (superDunension/Bronchus system; superDimension Inc; Plymouth, MN). Biopsy specimens were obtained through the extended working channel after navigation. Fluoroscopy was not utilized, but post-transbronchial biopsy chest radiographs were obtained to exclude pneumothorax. The primary end point was diagnostic yield, and the secondary end points were navigation accuracy, procedure duration, and safety. Analysis by lobar distribution was also performed to assess performance in different lobes of the lung. Results: Ninety-two peripheral lung lesions were biopsied in the 89 subjects. The diagnostic yield of ENB was 67%, which was independent of lesion size. Total procedure time ranged from 16.3 to 45.0 min (mean [± SD] procedure time, 26.9 ± 6.5 min). The mean navigation error was 9 ± 6 mm (range, 1 to 31 mm). There were two incidences of pneumothorax for which no intervention was required. When analyzed by lobar distribution, there was a trend toward a higher ENB yield in diagnosing lesions in the right middle lobe (88%). Conclusions: ENB can be used as a stand-alone bronchoscopic technique without compromising diagnostic yield or increasing the risk of pneumothorax. This may result in sizable timesaving and avoids radiation exposure.
AB - Background: Electromagnetic navigation bronchoscopy (ENB) with biopsy under fluoroscopic guidance has enhanced the yield of flexible bronchoscopy in the diagnosis of peripheral lung lesions. However, the accuracy of ENB navigation suggests that the addition of fluoroscopy is redundant. Objectives: Data were prospectively collected to determine the yield of ENB without fluoroscopy in the diagnosis of peripheral lung lesions. Method: ENB was performed via flexible bronchoscopy (superDunension/Bronchus system; superDimension Inc; Plymouth, MN). Biopsy specimens were obtained through the extended working channel after navigation. Fluoroscopy was not utilized, but post-transbronchial biopsy chest radiographs were obtained to exclude pneumothorax. The primary end point was diagnostic yield, and the secondary end points were navigation accuracy, procedure duration, and safety. Analysis by lobar distribution was also performed to assess performance in different lobes of the lung. Results: Ninety-two peripheral lung lesions were biopsied in the 89 subjects. The diagnostic yield of ENB was 67%, which was independent of lesion size. Total procedure time ranged from 16.3 to 45.0 min (mean [± SD] procedure time, 26.9 ± 6.5 min). The mean navigation error was 9 ± 6 mm (range, 1 to 31 mm). There were two incidences of pneumothorax for which no intervention was required. When analyzed by lobar distribution, there was a trend toward a higher ENB yield in diagnosing lesions in the right middle lobe (88%). Conclusions: ENB can be used as a stand-alone bronchoscopic technique without compromising diagnostic yield or increasing the risk of pneumothorax. This may result in sizable timesaving and avoids radiation exposure.
KW - Electromagnetic navigation bronchoscopy
KW - Peripheral lung lesion
KW - Solitary pulmonary nodule
KW - Transbronchial lung biopsy
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U2 - 10.1378/chest.06-3016
DO - 10.1378/chest.06-3016
M3 - Article
C2 - 17400670
AN - SCOPUS:34250866220
SN - 0012-3692
VL - 131
SP - 1800
EP - 1805
JO - CHEST
JF - CHEST
IS - 6
ER -