Cone-Beam CT-Assisted Electromagnetic Navigation Bronchoscopy for Challenging Peripheral Pulmonary Lesions

Area of Science:

• Pulmonology
• Medical Imaging
• Interventional Pulmonology

Background:

• Peripheral pulmonary lesions (PPLs) pose diagnostic challenges due to their location.
• Hybrid image-guided bronchoscopy, including electromagnetic navigation bronchoscopy (ENB), is increasingly utilized for PPL diagnosis.
• Cone-beam computed tomography (CBCT) offers real-time imaging during ENB procedures.

Purpose of the Study:

• To evaluate the diagnostic value of CBCT-assisted ENB for challenging peripheral pulmonary lesions (C-PPLs).
• To assess the safety and effectiveness of this hybrid approach in diagnosing small and peripherally located lung nodules.
• To compare diagnostic yields with and without specific imaging signs and explore the role of transbronchial lung cryobiopsy (TBLC).

Main Methods:

• Prospective, single-center study of patients with C-PPLs (nodules <20mm, beyond 6th bronchial generation).
• Utilized electromagnetic navigation bronchoscopy (ENB) integrated with cone-beam computed tomography (CBCT) for lesion localization and biopsy.
• Transbronchial lung cryobiopsy (TBLC) was employed as a diagnostic modality.

Main Results:

• A total of 63 C-PPLs were evaluated, with a mean size of 12.3mm.
• The overall diagnostic yield for CBCT-assisted ENB was 65.1% at index bronchoscopy, increasing to 73% post-adjudication.
• Diagnostic confirmation was achieved in 58% of lesions without a bronchus sign; TBLC yielded 65.6% and was the sole modality in 15.2% of cases. Mean radiation dose was 11.2mSv, with 4.7% pneumothorax rate and no major complications.

Conclusions:

• CBCT-assisted ENB is a safe and effective method for diagnosing C-PPLs, even without traditional imaging signs.
• TBLC is a valuable adjunct, providing high-quality tissue and improving diagnostic yield.
• This approach supports personalized, minimally invasive strategies for earlier and more accurate lung cancer detection.