title: Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield.
abstract: OBJECTIVE
  To determine factors associated with diagnostic yield of ENB.
  
  
  METHODS
  In 112 consecutive patients referred to our department between March 2010 and December 2010 the diagnostic work-up for solitary pulmonary lesions included a FDG-PET-CT scan, and ENB in combination with ROSE. The final diagnosis was confirmed by histopathological evaluation of specimen obtained either by ENB, or - if ENB was not diagnostic - by CT-guided fine needle aspiration or surgery.
  
  
  RESULTS
  Thirty-seven (33%) subjects were female, mean age was 66.7 (±1.04) years. The mean diameter of lesions was 27mm (range: 6-46mm). In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis, as defined by the definite histopathological result. 15.2% (17/112) of lesions were benign, and 84.8% (95/112) were malignant. For 112 procedures we observed a steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively. The diagnostic yield in lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively. No significant difference in diagnostic yield was seen depending on lung function, and the localization of the lesions. Two cases (1.8%) of pneumothorax were seen during and up to 24h after bronchoscopy, none of them required a chest tube.
  
  
  CONCLUSIONS
  Diagnostic yield increased with experience but was independent from the size of the lesion, the localisation in the lungs, and lung function. The diagnostic yield of ENB can be as high as for CT-guided transthoracic biopsies but carries a significantly lower complication rate.
authors.affiliation: Department of Pulmonary Medicine, Paracelsus Medical University Hospital, Muellner Hauptstrasse 48, A-5020 Salzburg, Austria. b.lamprecht@salk.at
authors.forename: B
authors.initials: B
authors.lastname: Lamprecht
authors.forename: P
authors.initials: P
authors.lastname: Porsch
authors.forename: B
authors.initials: B
authors.lastname: Wegleitner
authors.forename: G
authors.initials: G
authors.lastname: Strasser
authors.forename: B
authors.initials: B
authors.lastname: Kaiser
authors.forename: M
authors.initials: M
authors.lastname: Studnicka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D003937:Diagnosis, Differential; D004574:Electromagnetic Fields; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed