Electromagnetic Navigation Bronchoscopy (ENB) in patients with severe COPD.

Background: Indications for Electromagnetic navigation bronchoscopy (ENB) in patients with peripheral pulmonary nodules are increasing and extend to severe COPD patients ineligible for CT-guided biopsies. Aim and objective: We compared the feasibility, safety, and results of ENB between Severe COPD patients (SP) with FEV1 50%. Methods: In consecutive patients with peripheral pulmonary nodules, characteristics of the lesion, duration of ENB, and complications were prospectively recorded. ENB was performed under general anesthesia and OT intubation. Results: ENB was performed in 56 patients (60 nodules, including 6 GGO lesions). Twelve patients had severe COPD (mean FEV1: 37%, range: 22-50) and 44 were NMPs (mean FEV1: 79%, 53-120). There was no significant difference between the SP and NMP groups in terms of nodule mean size (23.9mm, range 12-37 vs 22.4mm, 11-55, respectively; p=0.7), SUVmax (10.9±6 vs 7.25±5, p=0.3), ENB duration (mean 35min, range 18-55 vs 38min, 18-55; p=0.1), and mean number of biopsies performed (8.4±1.1 vs 7.9±2.5; p=0.16). Final diagnoses (cancer, infection, non-growing lesion) were obtained in 10 SPs (83%) and 39 NMPs (88.6%). ENB-guided biopsies provided the diagnosis of cancer in 6 SPs (sensivity 67%; 95% CI: 30-93), and 17 NMPs (sensivity 55% 95% CI: 36-73). There were 3 peri-operative complications (5%), 2 pneumothoraces including 1 requiring needle aspiration, and 1 operative extreme bradycardia requiring atropin, all in the NMP group. Conclusion: ENB is feasible and safe in severe COPD patients, showing similar diagnostic yield and safety profile as in patients with no or moderate COPD.