Improved diagnostic yield for lung nodules with digital tomosynthesis-corrected navigational bronchoscopy: Initial experience with a novel adjunct.
BACKGROUND AND OBJECTIVE
The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is inferior to that of computed tomography (CT)-guided needle biopsy for pulmonary nodules. One explanation for this is divergence between the nodule location on the pre-procedure CT scan and its actual location during the procedure. Fluoroscopic ENB (F-ENB) consists of digital tomosynthesis using a conventional C-arm to re-register the target lesion based on near real-time imaging. We performed a retrospective review of ENB cases at our institution before and after introduction of F-ENB to assess diagnostic yield.


METHODS
All consecutive ENB procedures performed at our institution from 25 December 2017 to 25 August 2018 were reviewed. F-ENB was introduced on 25 April 2018. Two cohorts were analysed: standard ENB (S-ENB) from 25 December 2017 to 24 April 2018 and F-ENB from 25 April 2018 to 25 August 2018. All procedural, demographic and diagnostic data were collected. Descriptive statistics, chi-square, Wilcoxon test and Student's t-test were used where appropriate. A multivariable regression analysis was performed to assess factors associated with diagnostic yield.


RESULTS
A total of 101 and 67 nodules were biopsied in the S-ENB and F-ENB groups, respectively. Diagnostic yield was 54% in S-ENB cohort and 79% in the F-ENB group (P = 0.0019). Factors independently associated with a positive diagnosis were F-ENB and a positive radial ultrasound view (odds ratio (OR): 3.57, 95% CI: 1.56-8.18 and OR: 3.74, 95% CI: 1.37-11.05, respectively). Complications were minimal (pneumothorax: 1.5%).


CONCLUSION
The use of F-ENB may increase the diagnostic yield of ENB and has a low complication rate.
['Aboudara|Matt|M|https://orcid.org/0000-0001-8540-487X', 'Roller|Lance|L|', 'Rickman|Otis|O|', 'Lentz|Robert J|RJ|', 'Pannu|Jasleen|J|', 'Chen|Heidi|H|', 'Maldonado|Fabien|F|']
D000368:Aged D001999:Bronchoscopy D005260:Female D005471:Fluoroscopy D006801:Humans D061705:Image-Guided Biopsy D008168:Lung D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D055613:Multiple Pulmonary Nodules D011030:Pneumothorax D012189:Retrospective Studies D014057:Tomography, X-Ray Computed D014463:Ultrasonography
lung nodule navigational bronchoscopy tomosynthesis fluoroscopy