Electromagnetic navigation bronchoscopy: the initial experience in Hong Kong

Pulmonary nodules (PNs) are increasingly detected by thoracic computed tomography (CT). Traditional diagnostic modalities have their drawbacks. Electromagnetic navigation bronchoscopy (ENB) is gaining popularity in diagnosing small PNs. This study describes the diagnostic yield and complication rate of ENB in diagnosing PNs in which other diagnostic methods are considered to have low yield.

This is a retrospective study of the diagnostic yield and complication rate of ENB performed in the United Christian Hospital, Hong Kong, from April 2015 to June 2016. If a histological diagnosis was deemed necessary and flexible bronchoscopy (FB) was the preferred modality, patients were offered ENB if they have failed a conventional FB with fluoroscopy and radial endobronchoscopic ultrasonography (R-EBUS), or were perceived to have low yield because of the size or position of the PN.

During the study period, 99 patients received ENB. An overall of 87 patients had non-resolved CT lesions and had specific pathologies identified (87.9%). The total number of malignant PNs was 67 (67.7%) in the entire cohort and tuberculosis (TB) accounted for 14 PNs (14.1%). The overall accuracy by ENB was 71.7%, sensitivity 67.8%, specificity 100% and negative predictive value 30%. Complications occurred in 3 patients: 1 pneumothorax (1.0%), 1 post-transbronchial biopsy (TBBx) bleeding (1.0%), 1 respiratory failure (1.0%). No patient died as a result of ENB or its complications.

For PNs not accessible by conventional FB/R-EBUS, ENB provides good diagnostic yield with low complication rate. It is a useful armamentarium to respiratory physicians and thoracic surgeons.