Electromagnetic Navigation Bronchoscopy
Article Sidebar
Main Article Content
Abstract
OBJECTIVE: Suspicious pulmonary nodules have become a more common finding since the advent of CT scans as a screening method for lung cancer. The challenge is to find a safer, practical and more accurate way to diagnose peripheral nodules and lesions while minimizing harm to the patient. Electromagnetic Navigation Bronchoscopy (ENB) is a cutting edge technology that enables pulmonologists to precisely target small and difficult to reach peripheral pulmonary nodules by using technology similar to a global positioning system (GPS).This study describes our experience in using ENB with Endobronchial ultrasound (EBUS) as a diagnostic tool on patients suspected of lung malignancy.
MATERIALS AND METHODS: A retrospective analysis was conducted for 33 patients between November 2014 and November 2015 at our institution. Yield was determined by attaining final diagnosis from tissue analysis of every patient who underwent the ENB and EBUS procedure for suspected lung malignancy. Patients with no definite diagnosis were referred to surgery for further examination. Intraoperative and postoperative complications were recorded.
RESULTS: The ENB and EBUS procedure was completed in all 33 subjects on lung nodules measuring from 2 to 108mm. The patients were 67% (22) male, 33% (11) female, 88% (29) Asian, with a mean age of 61 years old. Lung nodules were located in the upper lobe (52%), lower lobe (43%) and middle lobe (5%). Lymph node involvement was present in 33% of cases. Of the patients in the study, 26 cases (79%) were accurately diagnosed using ENB and EBUS, 6 cases (18%) were referred to surgery and 1 patient (3%) refused further investigation. No bleeding or pneumothorax complications were reported.
CONCLUSION: ENB is an effective, accurate and a novel method that provides real time directions toward lung lesions and nodules. This tool allows flexibility that aids biopsy of hard to reach areas, and attains adequate tissue samples. This instrument compliments other bronchoscopic methods such as EBUS.
Article Details
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
2. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet 1999;354(9173):99-105
3. Laurent F, Michel P, Latrabe V, et al. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors. AJR Am J Roentgenol 1999;172(4):1049-53
4. Baaklini WA, Reinoso MA, Gorin AB, et al. Diagnostic yield of Fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000;117(4):1049-54
5. Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: When is it lung cancer? : ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl):108S-130S
6. Eberhardt R, Anantham D, Herth F, et al. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest 2007;131(6):1800-5
7. Seijo LM, Bastarrika G, Lozano MD, et al. Preliminary experience with use of electromagnetic navigation for the diagnosis of peripheral pulmonary nodules and enlarged mediastinal lymph nodes. Arch Bronconeumol 2007;43(8):460-3.
8. National Lung Screening Trial Research Team, Aberle DR,Adams AM, et al. Reduced lung cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365(5):395-409.
9. Pearlstein DP, Quinn CC, Burtis CC, et al. Electromagnetic navigation bronchoscopy performed by thoracic surgeons: one center’s early success. Ann Thorac Surg 2012;93(3):944-50.
10. Manser RL, Wright G, Byrnes G, et al. Validity of the assessment of quality of life (AQoL) utility instrument in patients with operable and inoperable lung cancer. Lung Cancer 2006; 53(2):217-2
11. Li H, Boiselle PM, Shepard J-AO, et al. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am Roentgenol 1996;167(1):105-9
12. Hiraki T, Mimura H, Gobara H, et al. Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy- guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol 2010; 194(3):809-14.
13. Choi YR, An JY, Kim MK, et al. The diagnostic efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration as an initial diagnostic tool. Korean J Intern Med 2013;28(6):660-7.
14. Varela-Lema L, Fernandez-Villar A, Ruano-Ravina. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J 2009;33(5):1156-64.
15. Gildea TR, Mazzone PJ, Karnak D, et al. Electromagnetic navigation diagnostic bronchoscopy. a prospective study. Am J Respir Crit Care Med 2006:174(9):982-9.
16. Brownback KR, Quijano F, Latham HE, Simpson SQ.Electromagnetic navigational bronchoscopy in the diagnosis of lung lesions. J Bronchol Intervent Pulmonol 2012;19(2):91-7