T ITLE : Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions

Objectives : This study evaluated prospectively the diagnostic yield and safety of electromagnetic navigation guided bronchoscopy biopsy, for small peripheral lung lesions in patients where standard techniques were non-diagnostic. Subjects and Methods: The study was conducted in a tertiary medical centre on 40 consecutive patients considered unsuitable for straightforward surgery or CT-guided transthoracic needle aspiration biopsy due to co-morbidities. Lung lesions mean(SE) diameter was 23.5(1.5)mm and depth from visceral-costal pleura was 14.9(2)mm. Navigation was facilitated by an electromagnetic tracking system which could detect a position sensor incorporated into a flexible catheter advanced through bronchoscope. Information obtained during bronchoscopy was superimposed on previously aquired CT-data. Divergence between CT-data and data obtained during bronchoscopy (divergence) was calculated by system(cid:146)s software as a measure of navigational accuracy. Results: All target lesions but one was reached and the overall diagnostic yield was 62.5%(25/40). Diagnostic yield was significantly affected by CT-to-body divergence (p=0.03); yield was 77.2% when estimated divergence was ≤ 4mm. Three pneumothoraces occurred and chest drainage was required in one case. Conclusion: Electromagnetic navigation guided bronchoscopy has the potential to improve the diagnostic yield of transbronchial biopsies without additional fluoroscopic guidance and may be useful in early diagnosis of lung cancer, particularly in non-operable patients.

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