T. D. Witek1, A. Pennathur1, J. D. Luketich1, M. Scaife1, D. Azar1, M. J. Schuchert1, W. E. Gooding2, O. Awais1 1University Of Pittsburgh Medical Center,Department Of Cardiothoracic Surgery,Pittsburgh, PA, USA 2University Of Pittsburgh Cancer Institute Biostatistics Facility,Pittsburgh, PA, USA
Introduction:
With increasing utilization of CT scans for lung cancer screening, and for surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. While CT-guided biopsies have been used for biopsies of peripheral lesions, electromagnetic navigational bronchoscopy (ENB) guided lung biopsy is a relatively new technique for bronchoscopic biopsies of peripheral lesions. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy (ENB) guided lung biopsy.
Methods:
We conducted a retrospective review of patients who underwent an ENB for diagnostic purposes, performed by a thoracic surgical service. We collected data on patient characteristics, lesion characteristics, procedure outcomes, and pathology information. General anesthesia and rapid on-site examination (ROSE) of cytopathology was used during all ENBs. All patients that were diagnosed with a malignancy from ENB findings were considered true positives. Lesions that did not reveal malignancy from ENB sampling were considered true negatives if sequential surgical or CT guided biopsy also revealed benign tissue or if serial imaging revealed stability or improvement; otherwise they were classified as false negatives.
Results:
A total of 121 lesions in 111 patients (men 46, women 65) underwent ENB guided bronchoscopic sampling of pulmonary lesions. The median size of the lesion was 27mm (Range 9-115 mm, IQR = 17 – 37 mm). Ninety-four (78%) of the lesions were malignant. Eighty-five (70%) of the 121 lesions had an accurate diagnosis. Accuracy increased with increased lesion size (odds ratio = 2.9, 95% CI = 1.3 – 6.3). The presence of “bronchus sign” was associated with 3 fold increase in odds of accurate diagnosis (odds ratio 3.1, 95% CI= 1.1 – 8.2). Among patients with a “bronchus sign”, the predicted accuracy of the biopsies for 1 cm lesions was 66% (95% CI 40% – 85%; the predicted accuracy for 2 cm lesions was 77% (95% CI = 58% – 89%) for 3 cm lesions 85% (95% CI = 71% – 93%). There was no procedure-related mortality. There were four (3%) instances of pneumothoraxes, requiring pigtail pleural catheters.
Conclusion:
Thoracic surgeons can perform ENB safely, with minimal morbidity and with good diagnostic yields. Accuracy increases with the presence of "bronchus sign" and increasing lesion size. Lesions larger than 2 cm have a higher likelihood of an accurate diagnosis.
