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.
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.
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.
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: firstname.lastname@example.org).
Received for publication July 29, 2007; accepted September 6, 2007
Conflict of interest statement: No conflict of interest to report.