Electromagnetic Navigation Bronchoscopy for Peripheral Lung Lesions: Factors Associated with Improved Diagnostic Yield
Summer N. Rochester1, William D. Bolton2, John S. Richey1, Joseph A. Ewing1, Allyson L. Hale1, Tiffanie Aiken3, Beatriz Bassaco1, Benjamin C. Powell1, James E. Stephenson1, Sharon Ben-Or2, 1Greenville Health System, Greenville, SC, USA, 2Greenville Health System, USC School of Medicine Greenville, Greenville, SC, 3USC School of Medicine Greenville, Greenville, SC
OBJECTIVE: The reported diagnostic yield of Electromagnetic navigation bronchoscopy (ENB) for peripheral nodules ranges from 59% to 93%. The aim of this study was to evaluate lesion factors and their impact on ENB yield.
METHODS: We reviewed all patients (N=268) who underwent ENB with biopsy between June 2010 and October 2015. Data collection included location, size, ENB pathology, confirmatory method and pathology, and nodule distance from both the pleura and the nearest major airway on the pathway created from preoperative imaging. Multivariate ordered logistic regression analysis was performed to identify predictive factors for a true positive (TP) biopsy.
RESULTS: 284 lesions were biopsied. Total diagnostic yield for all lesions was 76%, with the middle (83%) and upper lobes (81%) having the best yield and the left lower lobe (LLL) having the worst (59%). Larger nodules (>2.1 cm) were 78% more likely to result in a TP than nodules <1 cm [odds ratio (OR)=1.78, confidence interval (CI)=0.97-3.28)]. Nodules in the LUL were 3x more likely to result in a TP than those in the LLL (OR=3.06, CI=1.26-7.78). Distance from the closest airway was also significant, with every additional cm from the airway resulting in a 22% reduced likelihood of getting a TP (OR=0.78, CI=0.69-0.89) (Table SA-6-1).
CONCLUSIONS: We found the LLL location to be associated with a lower chance of successfully diagnosing malignancy when controlling for factors such as lesion size, airway and pleural distance. We also found distance to the closest major airway (based on preoperative imaging) to be predictive of higher success.
Table SA-6-1. Diagnostic Yield by Lesion Size and Distance from Airway
|N||TP (%)||TN (%)||Diagnostic Yield|
|Lesion Size, cm|
|0.5-1||18||4 (22.2)||7 (38.9)||61.1|
|1.01-1.5||63||24 (38.1)||24 (38.1)||76.2|
|1.51-2.0||58||34 (58.6)||11 (19.0)||77.6|
|>2.1||144||78 (54.2)||33 (22.9)||77.1|
|Distance from Airway, cm|
|<1.0||69||46 (66.7)||11 (15.9)||82.6|
|1.01-2.0||24||15 (62.5)||5 (20.8)||83.3|
|2.01-3.0||55||30 (54.6)||11 (20.0)||74.6|
|3.01-4.0||56||23 (41.1)||21 (37.5)||78.6|
|4.01-5.0||34||8 (23.5)||15 (44.1)||67.6|
|>5.01||46||18 (39.1)||13 (28.2)||67.4|
|TP, true positive; TN, true negative|