Navigational Bronchoscopy for the Evaluation of Peripheral Pulmonary Lesions

Rebecca J Johnson, MD, Brent L Johnson, MS, James S Stephenson, MD, William D Bolton, MD

Greenville Hospital System University Medical Center Division of Thoracic Surgery; University of Kentucky Division of Cardiothoracic Surgery

Introduction: Electromagnetic navigational bronchoscopy allows sampling of peripheral pulmonary lesions not accessible by traditional bronchoscopy. The purpose of this study was to evaluate the utility of navigational bronchoscopy at our regional teaching institution.

Methods: Our thoracic surgery database was reviewed for all patients undergoing navigational bronchoscopy between June 2010 and May 2012. A retrospective medical record review was conducted for each patient.

Results: 89 navigational bronchoscopy procedures were performed during this period. Eight patients already carried a diagnosis of lung cancer and navigational bronchoscopy was performed solely to place fiducial markers. One patient was immediately lost to follow-up, giving a total of 80 diagnostic navigational bronchoscopy procedures. A definitive diagnosis was yielded for 68 samples (diagnostic yield: 85%) with the remaining 12 samples identified as “atypical”. Diagnoses included benign tissue (n=33, 48.5%), non small cell lung cancer (n=32, 47.1%), neuroendocrine tumor (n=2, 2.9%), and metastatic disease (n=1, 1.5%). Of the 33 patients with benign samples, 12 (36.4%) underwent subsequent resection or CT-guided biopsy due to clinical suspicion of malignancy; 4 (33.3%) were found to be NSCLC. An additional five (15.2%) patients with a pathologic diagnosis of benign disease were treated with radiation therapy due to high clinical suspicion of malignancy. The overall sensitivity was 79.5%. Pneumothorax occurred in 5 (5.6%) of 89 patients with an overall complication rate of 11%.

Conclusion: Navigational bronchoscopy is a feasible and safe manner in which to obtain tissue samples of pulmonary lesions for diagnosis, with an acceptable diagnostic rate and a low rate of complications.

Session: Poster Presentation

Program Number: P493

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