Navigation Bronchoscopy For Peripheral Pulmonary Lesions

Objectives1.To determine the diagnostic value and factors influencing diagnostic yield of transbronchial sampling assisted by the navigation system for peripheral pulmonary lesions(PPLs)in our clinical trial center.2.To provide theoretical basis for a better choice of diagnosis methods,by means of comparing the diagnostic value and safety of transbronchial navigation system,endobronchial ultrasonography(EBUS)and computed tomography(CT)-guided percutaneous transthoracic needle biopsy(PTNB)for PPLs.3.To determine the feasibility and safety of electromagnetic navigational bronchoscopy(ENB)with pleural dye to locate small peripheral pulmonary nodules(PPNs)before video-associated thoracic surgery(VATS),and present our initial experiences with this method.Methods1.Three-dimensional(3D)virtual bronchoscopic images were reconstructed from two-dimensional chest CT imaging series using a navigation system for the selection of the optimal path for endobronchial sampling.2.Cases using a navigation system as a diagnostic tool were selected as the experimental group("navigation group"),and who underwent EBUS-guided transbronchial("EBUS group")and CT-guided percutaneous sampling("CT-PTNB group")were collected as control groups.The three groups were compared to determine the diagnostic yield and safety of different diagnostic tools for PPLs.3.The ENB-localization procedure was performed in an operating room.Once the locatable guide wire,covered with a sheath,reached the ideal location,it was withdrawn and 0.2-1.0 mL of dyes was injected through the guide sheath(GS).VATS was then performed immediately.Results1.A total of 65 patients with 66 lesions underwent transbronchial sampling using the navigation system.The average lesion size was 26.0mm.A diagnosis was obtained in 34 lesions(51.5%).In the univariate analysis,lesions>25mm had significantly higher diagnostic yield than the lesions<25mm(66.7%vs 36.4%p=0.014).In the multivariate analysis,lesion size was significantly associated with successful bronchoscopic diagnosis(odd ratio(OR),3.50;95%confidence interval(CI),1.27-9.64).Complications were observed in 4 cases,including 3 pneumothoraces with one requiring drainage and one hemorrhage.2.A total of 197 patients with 198 lesions were studied.There were 65 cases in the "navigation group" with lesion size 26.0mm,66 in the "EBUS group" and"CT-PTNB group" with lesion size 24.1mm and 23.2mm,respectively.For lesions ≤25mm,located in the upper lobe of both lungs or the middle or outer lung fields,the diagnostic yield of "CT-PTNB group" was significantly higher than that of "navigation group"(p<0.05),while no significant difference was observed between "navigation group" and "EBUS group".For lesions>25mm,located in the middle lobe of the right lung/lingual lobe of the left lung,lower lobe of both lungs or the interior of the lung field,the diagnostic yield among the three groups did not differ significantly.The incidences of complications for the "navigation group","EBUS group",and "CT-PTNB group" were 6.1%,4.5%,and 12.1%respectively,and no significant differences were observed(p=0.225).3.In the group of ENB-guided localization,31 patients with 35 pulmonary nodules were included.The median largest diameter of the nodules was 10.0 mm,and the median distance from the nearest pleural surface was 10.3mm.After the ENB-guided localization procedure was completed,the dye was visualized in 30 nodules.The success rate of localization was 85.7%(30/35).The median duration of the ENB-guided pleural dye-marking procedure was10 minutes.No Complications related to the ENB-guided localization procedure occurred.Conclusions1.The diagnostic yield can reach more than 50%through navigation system for PPLs.The lesion size significantly affects the diagnostic yield,with the diagnosis yield of lesions>25mm significantly higher than that of lesions ≤25mm.2.For lesions>25mm,located in the middle lobe of the right lung/lingual lobe of the left lung,lower lobe of both lungs or the interior of the lung field,we can choose navigation system as a diagnostic tool,which is more safe than CT-PTNB.3.ENB can be used to safely and effectively to locate small pulmonary nodules,and guide surgical resection.