Lesion characteristics affecting yield of electromagnetic navigational bronchoscopy

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Imaging

Background:

• Electromagnetic navigational bronchoscopy (ENB) is a minimally invasive tool for diagnosing peripheral lung lesions.
• Optimal sampling techniques and lesion characteristics for ENB require further investigation.

Purpose of the Study:

• To evaluate the sensitivity and diagnostic yield of various sampling modalities used with ENB.
• To assess the impact of lesion characteristics, specifically Tsuboi classification, on ENB performance.
• To determine the added value of radial probe endobronchial ultrasound (EBUS) in conjunction with ENB.

Main Methods:

• Retrospective chart review of 248 patients undergoing ENB between 2011 and 2018.
• Analysis of lesion size, location, Tsuboi classification, and biopsy specimen types (needle aspiration, brush biopsy, forceps biopsies).
• Evaluation of sensitivity and diagnostic yield for malignancy.

Main Results:

• ENB achieved a 59.2% sensitivity for malignancy and a 72.3% overall diagnostic yield in 270 targeted lesions.
• Combined sampling modalities demonstrated higher sensitivity and diagnostic accuracy.
• Tsuboi types I and II bronchus signs showed significantly higher sensitivity (67.9% and 64.6%) compared to type III (37.9%).

Conclusions:

• ENB sensitivity is significantly influenced by the Tsuboi classification of the bronchus sign.
• Lesions with Tsuboi types I and II, where the airway directly leads to the lesion, yield better results than type III.
• Combined sampling strategies enhance the diagnostic efficacy of ENB for peripheral lung lesions.