title: Electromagnetic navigation transthoracic needle aspiration for the diagnosis of pulmonary nodules: a safety and feasibility pilot study.
abstract: BACKGROUND
  Pulmonary nodules remain a diagnostic challenge for physicians. Minimally invasive biopsy methods include bronchoscopy and CT guided transthoracic needle aspiration (TTNA). A novel electromagnetic guidance transthoracic needle aspiration (ETTNA) procedure which can be combined with navigational bronchoscopy (NB) and endobronchial ultrasound (EBUS) in a single setting has become available.
  
  
  METHODS
  A prospective pilot study examining the safety, feasibility and diagnostic yield of ETTNA in a single procedural setting. All patients enrolled underwent EBUS for lung cancer staging followed by NB and ETTNA. Feasibility of performing ETTNA and a safety assessment by recording procedural related complications including pneumothorax or bleeding was performed. Diagnostic yield of ETTNA defined by a definitive pathologic tissue diagnosis was recorded. An additional diagnostic yield analysis was performed using a cohort analysis of combined interventions (EBUS + NB + ETTNA). All non-diagnostic biopsies were either followed with radiographic imaging or a surgical biopsy was performed.
  
  
  RESULTS
  Twenty-four subjects were enrolled. ETTNA was feasible in 96% of cases. No bleeding events occurred. There were five pneumothoraces (21%) of which only two (8%) subjects required drainage. The diagnostic yield for ETTNA alone was 83% and increased to 87% (P=0.0016) when ETTNA was combined with NB. When ETTNA and NB were performed with EBUS for complete staging, the diagnostic yield increased further to 92% (P=0.0001).
  
  
  CONCLUSIONS
  This is the first human pilot study demonstrating an acceptable safety and feasibility profile with a novel ETTNA system. Further studies are needed to investigate the increased diagnostic yield from this pilot study.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Lonny B
authors.initials: LB
authors.lastname: Yarmus
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Sixto
authors.initials: S
authors.lastname: Arias
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Semaan
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Ko Pen
authors.initials: KP
authors.lastname: Wang
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Bernice
authors.initials: B
authors.lastname: Frimpong
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Oakjones Burgess
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Thompson
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Chen
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ortiz
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; 2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 Division of Pulmonary and Critical Care Medicine, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Lee
keywords: Bronchoscopy; interventional techniques; lung cancer