Improved Diagnostic Yield of Bronchoscopy in a Community Practice: Combination of Electromagnetic Navigation System and Rapid On-site Evaluation

Wilson, David S. MD; Bartlett, Rebecca J. RN, BSN

doi: 10.1097/LBR.0b013e31815a7b00
Original Investigations

Background: Several techniques are currently available to improve the diagnostic yield of routine flexible bronchoscopy. In the present study, we have evaluated the contribution of 2 methods used in our community practice: electromagnetic navigation (EMN, superDimension Ltd, Herzliya, Israel) and rapid on-site cytologic evaluation of obtained tissue samples. The main purpose of the study was to determine the percentage of patients that had a malignant diagnosis or a plausible nonmalignant diagnosis on the day of the procedure.

Materials and Methods: Consecutive patients that had EMN-assisted biopsy procedures between June 2005 and July 2006 were studied. Patient records were retrospectively reviewed by the author to determine performance of above-mentioned system, diagnostic yield of flexible bronchoscopy, and adverse events. The majority of patients were followed-up for confirmation of final diagnosis and/or for treatment.

Results: A total of 248 patients were included. Mean size of the targeted peripheral lesions and lymph nodes was 2.1±1.4 (SD) cm and 1.8±0.9 (SD) cm, respectively. Mean follow-up period was 6±5 (SD) months. The majority (51%) of the peripheral lesions were in the upper lung lobes. EMN was successful, and tissue samples were obtained from 96% of the peripheral lesions, and 94.3% of the lymph nodes. On the day of the procedure, 161/248 (65%) patients received a definitive malignant or plausible nonmalignant diagnosis. With additional clinical follow-up, 12 patients (5%) with a nonmalignant diagnosis on the day of the procedure were confirmed as having no disease, 8 patients (3%) were confirmed as having malignant disease, and 67 patients (27%) remained inconclusive due to lack of clinical follow-up information, leading to total of 173/248 (70%) of diagnostic cases. Thus, when all inconclusive cases are treated as nondiagnostic, the yield is 70%, and when the estimate of the percent of diagnostic and nondiagnostic cases from the observed data is applied to the inconclusive cases, the estimate of diagnostic yield is 86%. Eight complications occurred; moderate bleeding (3), pneumothorax (3), hematoma (1), and pneumonia with exacerbation of chronic obstructive pulmonary disease (1). None of the complications were related to use of the EMN system.

Conclusions: EMN is safe and provides a new noninvasive diagnostic option for smaller peripheral lung lesions and enlarged mediastinal lymph nodes. In a community based practice, EMN in combination with rapid on-site cytologic evaluation can provide for patients with a lung lesion, diagnosis in an expeditious and effective manner.

Columbus Regional Hospital, Lung Center, Columbus, IN

Reprints: David S. Wilson, MD, Columbus Regional Hospital, Lung Center, 2400 East 17th Street, Columbus, IN 47201 (e-mail: dwilson1@crh.org).

Received for publication July 29, 2007; accepted September 6, 2007

Conflict of interest statement: No conflict of interest to report.

© 2007 Lippincott Williams & Wilkins, Inc.