The Value And Multifactorial Analysis Of Electromagnetic Navigation Bronchoscopy In The Diagnosis And Treatment Of Pulmonary Nodules

Background and Purpose:Diagnosis of pulmonary nodules has been the focus and difficulty of diagnosis and treatment in the field of lung disease,essential for surgical treatment decisions.Conventional biopsy ways include:Traditional bronchoscopic biopsy,percutaneous needle biopsy,ultrasound bronchoscopic biopsy and electromagnetic navigation bronchoscopic biopsy(ENB).Use of an electromagnetic solenoid bronchoscope navigation positioning,the positioning system using the image guided steerable tool bronchoscope directed to a predetermined point in the bronchial tree,the ENB has matured for pathological diagnosis of lung lesions.Previous studies have reported the electromagnetic navigation bronchoscopy biopsy detection rate for malignant lung lesion fluctuated around 30%-95%,for some patients undergoing electromagnetic navigation bronchoscopy failed to clear evidence of tumor biopsy who may delay their treatment,prognosis.This study is based on our center operating practices,analysis of electromagnetic navigation bronchoscopy biopsy initial pathology and surgical pathology finally get to explore electromagnetic navigation bronchoscopy and biopsy pathologic diagnosis final distribution and predictors.Method:Retrospectively analyzed 2017.02-2019.09 our center to carry out electromagnetic navigation bronchoscopy biopsy cases,and ultimately reviewed the electromagnetic navigation bronchoscopy biopsy next surgical removal of lesions to get final pathology in patients with 194 cases,of which 198 biopsy nodules,nodules different cases in which the same live view as an independent event.Biopsy of different nodules in the same patient as independent events.The initial pathology was obtained by biopsy,and the final pathological results were confirmed by pneumonectomy,including video-assisted thoracoscopic surgery and open pneumonectomy.The initial biopsy pathology results were divided into two groups: diagnostic groups and non-diagnostic groups.The diagnostic group was defined as : initial biopsy successfully diagnosed,including malignant and benign diagnosis.The non-diagnostic group was defined as: non-specific benign diagnosis or normal lung tissue or unsuccessful materials.The clinical and pathological data of the patients was collected through the hospital electronic medical record system.Measurement data and count data were tested by t test and Chi-square test,respectively.Clinical pathological characteristics with statistical differences were further analyzed by logistic regression model,so as to screen out the initial non-diagnostic risk predictors and risk predictors that the biopsy pathology did not match the final pathology.Resluts:Of 198 electromagnetic bronchoscopy biopsies included,139(70.2%)were diagnosed as malignant and benign in the initial biopsy,and 59(29.8%)were in the non-diagnostic group.Among them,119 cases were diagnosed as malignant and 20 cases were benign in the diagnostic group;46 cases were malignant and 13 cases were benign in the non-diagnosis group.Among all cases,165 cases were eventually diagnosed as malignant,accounting for 83.3%.There were 33 cases of benign diseases,being accountable for16.7%.In the diagnosis group and the non-diagnosis group,the clinical and imaging data of patients showed significant differences in nodule size,morphology,CT value,and position(P <0.05),and nodule contact with the pleura also had significant differences(P = 0.02).No significant difference was noted in other data.Of the 139 diagnosis group cases,69 initial diagnoses were consistent with the final pathology,and 70 initial diagnoses were not consistent with the final pathology.Of the 59 non-diagnostic groups,46 had a final pathological result of malignant tumors and 13 had a definitive pathological result of benign.78.0% of non-diagnosed cases were finally surgically verified to be malignant.In the diagnosis group,the sensitivity of the electromagnetic navigation bronchoscopy biopsy was 42.8%;the specificity was 100%;the positive predictive value was 100%;the negative predictive value was 22.7%.The risk predictive factors in the non-diagnosed group were:nodule size ? 1.5 cm(P = 0.04,OR = 2.05,95%CI = 1.03-4.09),non-solid nodules(cystic cavity type,pure GGO,mixed GGO)(P = 0.01 OR = 2.74,95%CI = 1.33-5.64)and nodules in the left lung(P<0.01,OR = 2.50,95% CI = 1.27-4.92)were independent risk factors for non-diagnosis of the initial biopsy.Non-solid nodules,including: cystic cavity type,pure GGO,mixed GGO(P <0.05,OR = 7.64,95% CI = 3.11-18.76)were independent risk factors for missed detection in the initial non-diagnostic group.Nodule size ? 1.5cm(P = 0.043,OR = 1.94,95% CI = 1.02-3.71);non-solid nodules,including:cystic cavity type,pure GGO,mixed GGO(P <0.05,OR = 3.37(95% CI = 1.81-6.30)is an independent risk factor that the biopsy pathology does not match the final surgical pathology.Conclusion:Nodule size>1.5 cm and GGO nodules are prone to electromagnetic bronchoscopy biopsy success.In cases where the biopsy fails,it is not uncommon for patients final to be malignancy.Therefore,care should be taken when the results of the electromagnetic navigation biopsy are non-malignant to prevent misdiagnosis and missed diagnosis.