Use of navigation bronchoscopy for biopsy and endobronchial fiducial placement

Electromagnetic navigation bronchoscopy (ENB) is a technique that can be used to biopsy pulmonary lesions beyond areas that are traditionally accessible by bronchoscopy. It can also guide biopsies of peribronchial lymph nodes and guide the placement of fiducial markers for stereotactic radiosurgery. With ENB, the patient is placed in a magnetic field and their anatomy is merged with a 3D reconstructed chest cat scan (CCT). A locatable, steerable probe is used to guide a working channel to the target, usually a peripheral tumor. Biopsies can be taken, and markers can be placed. The accuracy of this system depends largely on a small bronchus leading toward to target. The diagnostic yield is similar to CT-guided biopsies, with a false-negative rate of about 30%, although results may be improved with combined ENB and radial endoscopic ultrasound (EUS). The incidence of pneumothorax is 5% to 8% with ENB-directed biopsies compared with approximately 30% with CT-guided transthoracic biopsy.