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Electromagnetic Navigation Diagnostic Bronchoscopy

A Prospective Study

Department of Pulmonary, Allergy and Critical Care Medicine, and Department of Radiology, The Cleveland Clinic Foundation, Cleveland, Ohio; and Ankara University School of Medicine, Department of Chest Diseases, Ankara, Turkey

Correspondence and requests for reprints should be addressed to Thomas R. Gildea, M.D., Associate Staff, Department of Pulmonary, Allergy and Critical Care Medicine, The Cleveland Clinic Foundation, Desk A-90, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: gildeat{at}ccf.org

Rationale: Electromagnetic navigation bronchoscopy using superDimension/Bronchus System is a novel method to increase diagnostic yield of peripheral and mediastinal lung lesions.

Objectives: A prospective, open label, single-center, pilot study was conducted to determine the ability of electromagnetic navigation bronchoscopy to sample peripheral lung lesions and mediastinal lymph nodes with standard bronchoscopic instruments and demonstrate safety.

Methods: Electromagnetic navigation bronchoscopy was performed using the superDimension/Bronchus system consisting of electromagnetic board, position sensor encapsulated in the tip of a steerable probe, extended working channel, and real-time reconstruction of previously acquired multiplanar computed tomography images. The final distance of the steerable probe to lesion, expected error based on the actual and virtual markers, and procedure yield was gathered.

Measurements: 60 subjects were enrolled between December 2004 and September 2005. Mean navigation times were 7 ± 6 min and 2 ± 2 min for peripheral lesions and lymph nodes, respectively. The steerable probe tip was navigated to the target lung area in all cases. The mean peripheral lesions and lymph nodes size was 22.8 ± 12.6 mm and 28.1 ± 12.8 mm. Yield was determined by results obtained during the bronchoscopy per patient.

Results: The yield/procedure was 74% and 100% for peripheral lesions and lymph nodes, respectively. A diagnosis was obtained in 80.3% of bronchoscopic procedures. A definitive diagnosis of lung malignancy was made in 74.4% of subjects. Pneumothorax occurred in two subjects.

Conclusion: Electromagnetic navigation bronchoscopy is a safe method for sampling peripheral and mediastinal lesions with high diagnostic yield independent of lesion size and location.

Key Words: diagnostic bronchoscopy • electromagnetic navigation • mediastinal lymph node • solitary pulmonary nodule • transbronchial biopsy

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