Diagnostic yield and complications associated with electromagnetic navigation bronchoscopy in peripheral lung lesions

Introduction: Electromagnetic navigation bronchoscopy (ENB) is a procedure that facilitates sampling of peripheral lung lesions and avoid more invasive diagnostic methods. Objective: To determine the factors associated with the diagnostic yield and adverse events (AE) of ENB. Method: A prospective study of ENB in 180 consecutive cases, between March 2008 and October 2013. ENB was chosen as the least invasive diagnostic technique in patients with high surgical risk, suspicious cancer lesion, or in those who demanded a preoperative diagnosis prior to undergoing curative resection. Results: The overall diagnostic yield of ENB was 50.6%. It was diagnostic in 62.8% (88/140) of patients with bronchus sign and only in 0.07% (3/40) of those without the bronchus sign (OR 20.9; 95% CI=6.1-71.1). The average of lesion diameter (LD) was 29.6 vs 17.6 mm in diagnostic and non-diagnostic ENB, respectively (p<.001). On multivariate analysis, both were independent factors for the ENB yield (p<.001). 65/180 cases were cancer (80% primary), the most frequent was lung adenocarcinoma (27 cases, 42%). General anesthesia was used in 24/180 cases (13.3%), and diagnostic in 62% of these patients, without significant difference when used conscious sedation. Age, sex, BMI, smoking, emphysema, location, consistency, and biopsies and/or fine needle aspiration number were not associated to the success of the ENB. As AE, 5% (9/180) had pneumothorax, not associated to the type of anesthesia used. No patient had bronchial bleeding, sedation adverse reaction or death. Conclusions: The ENB diagnostic yield is dependent on the presence of the bronchus sign and LD. This is a safe technique with few AE.