Diagnostic utility of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary lesions_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Min ¹ , SHI Shenyun ¹ , LI Yan ¹ , YU Yanzhe ¹ , ZHAO Tingting ¹ , XU Qingqing ¹ , ZHAO Qi ¹ , DING Jingjing ¹ , FENG Anning ² , DAI Jinghong ¹ ,  XIAO Yonglong ¹

1. Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;
2. Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;

Corresponding?author：

XIAO Yonglong, Email: yonglong11a@163.com

Keywords：

Electromagnetic navigation bronchoscopy; radial endobronchial ultrasound; peripheral pulmonary lesion

DOI：

10.7507/1007-4848.202106029

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Objective To investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules.Methods The clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate.Results Pulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups.Conclusion Electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.

Citation： YU Min, SHI Shenyun, LI Yan, YU Yanzhe, ZHAO Tingting, XU Qingqing, ZHAO Qi, DING Jingjing, FENG Anning, DAI Jinghong, XIAO Yonglong. Diagnostic utility of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary lesions. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 44-49. doi: 10.7507/1007-4848.202106029 Copy

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2.	Ernst A, Eberhardt R, WahidiM, et al. Effect of routine clopidogrel use on bleeding conplications after transbronchial biopsy in humans. Chest, 2006, 129(3): 734-737.
3.	Siegel R L, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin, 2016, 66(1): 7-30.
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7.	Wang MJ, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest, 2012, 142(2): 385-393.
8.	Ost DE, Ernst A, Lei X, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med, 2016, 193(1): 68-77.
9.	Tanner NT, Yarmus L, Chen A, et al. Standard bronchoscopy with fluoroscopy vs thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: A multicenter, prospective, randomized trial. Chest, 2018, 154(5): 1035-1043.
10.	Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE Study. J Thorac Oncol, 2019, 14(3): 445-458.
11.	薛孟華, 汪建, 韓勇, 等. 電磁導航支氣管鏡在肺外周結節診斷中的應用. 中國肺癌雜志, 2020, 23(6): 446-450.
12.	黃海濤, 陳少慕, 潘良斌, 等. 電磁導航支氣管鏡聯合徑向探頭支氣管內超聲在肺周圍型病灶診斷中的應用. 中國肺癌雜志, 2017, 20(12): 837-840.
13.	吳寶妹, 李玉梅, 侯黎莉, 等. 電磁導航支氣管鏡在肺外周結節診斷中的意義. 中華診斷學電子雜志, 2016, 4(3): 203-205.
14.	Bechara R, Parks C, Ernst A. Electromagnetic navigation bronchoscopy. Future Oncol, 2011, 7(1): 31-36.
15.	王功銘, 林勇斌, 羅孔嘉, 等. 電磁導航支氣管鏡引導下注入熒光劑在肺結節定位切除術中可行性. 中國肺癌雜志, 2020, 23(6): 503-508.
16.	Awais O, Reidy MR, Mehta K, et al. Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg, 2016, 102(1): 223-229.
17.	Hagmeyer L, Priegnitz C, Kocher M, et al. Fiducial marker placement via conventional or electromagnetic navigation bronchoscopy (ENB): An interdisciplinary approach to the curative management of lung cancer. Clin Respir J, 2016, 10(3): 291-297.
18.	陳求名, 安舟, 馬洪海, 等. 經電磁導航氣管鏡微波消融治療肺結節研究進展. 中國胸心血管外科臨床雜志, 2020, 27(7): 830-833.
19.	Narsule CK, Sales Dos Santos R, Gupta A, et al. The efficacy of electromagnetic navigation to assist with computed tomography-guided percutaneous thermal ablation of lung tumors. Innovations (Phila), 2012, 7(3): 187-190.

1. Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: When is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 108S-130S.
2. Ernst A, Eberhardt R, WahidiM, et al. Effect of routine clopidogrel use on bleeding conplications after transbronchial biopsy in humans. Chest, 2006, 129(3): 734-737.
3. Siegel R L, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin, 2016, 66(1): 7-30.
4. Roth JA, Sullivan SD, Goulart BH, et al. Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in medicare. J Oncol Pract, 2015, 11(4): 267-272.
5. Tanoue LT, Tanner NT, Gould MK, et al. Lung cancer screening. Am J Respir Crit Care Med, 2015, 191(1): 19-33.
6. Gould MK, Ananth L, Barnett PG. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest, 2007, 131(2): 383-388.
7. Wang MJ, Nietert PJ, Silvestri GA. Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest, 2012, 142(2): 385-393.
8. Ost DE, Ernst A, Lei X, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med, 2016, 193(1): 68-77.
9. Tanner NT, Yarmus L, Chen A, et al. Standard bronchoscopy with fluoroscopy vs thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: A multicenter, prospective, randomized trial. Chest, 2018, 154(5): 1035-1043.
10. Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE Study. J Thorac Oncol, 2019, 14(3): 445-458.
11. 薛孟華, 汪建, 韓勇, 等. 電磁導航支氣管鏡在肺外周結節診斷中的應用. 中國肺癌雜志, 2020, 23(6): 446-450.
12. 黃海濤, 陳少慕, 潘良斌, 等. 電磁導航支氣管鏡聯合徑向探頭支氣管內超聲在肺周圍型病灶診斷中的應用. 中國肺癌雜志, 2017, 20(12): 837-840.
13. 吳寶妹, 李玉梅, 侯黎莉, 等. 電磁導航支氣管鏡在肺外周結節診斷中的意義. 中華診斷學電子雜志, 2016, 4(3): 203-205.
14. Bechara R, Parks C, Ernst A. Electromagnetic navigation bronchoscopy. Future Oncol, 2011, 7(1): 31-36.
15. 王功銘, 林勇斌, 羅孔嘉, 等. 電磁導航支氣管鏡引導下注入熒光劑在肺結節定位切除術中可行性. 中國肺癌雜志, 2020, 23(6): 503-508.
16. Awais O, Reidy MR, Mehta K, et al. Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg, 2016, 102(1): 223-229.
17. Hagmeyer L, Priegnitz C, Kocher M, et al. Fiducial marker placement via conventional or electromagnetic navigation bronchoscopy (ENB): An interdisciplinary approach to the curative management of lung cancer. Clin Respir J, 2016, 10(3): 291-297.
18. 陳求名, 安舟, 馬洪海, 等. 經電磁導航氣管鏡微波消融治療肺結節研究進展. 中國胸心血管外科臨床雜志, 2020, 27(7): 830-833.
19. Narsule CK, Sales Dos Santos R, Gupta A, et al. The efficacy of electromagnetic navigation to assist with computed tomography-guided percutaneous thermal ablation of lung tumors. Innovations (Phila), 2012, 7(3): 187-190.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnostic utility of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary lesions

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