title: Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions.
abstract: OBJECTIVE
  Electromagnetic navigation bronchoscopy (ENB) is a promising new technology to increase the diagnostic yield of peripheral lung and mediastinal lesions. Conventional flexible bronchoscopy has a limited yield in peripheral pulmonary lesions, even in experienced hands. Radial endobronchial ultrasound (r-EBUS) with its real-time imaging capability can help to diagnose peripheral pulmonary lesions. In the present study, we aimed to investigate the diagnostic yield and safety of ENB with or without r-EBUS for peripheral lung lesions.
  
  
  METHODS
  This study was conducted in a tertiary medical center, and 56 consecutive patients who were thought to be the best candidates for bronchoscopic biopsies at a multidisciplinary meeting were enrolled. ENB was performed under conscious sedation by using an electromagnetic tracking system with multiplanar reconstruction of previously acquired computed tomography (CT) data. Sampling was performed by biopsy forceps, endobronchial brush, and bronchoalveolar lavage.
  
  
  RESULTS
  Fifty-six patients (50 men and 6 women; mean age, 60 ± 9 years) were studied. While an electromagnetic navigation system was used in all patients, r-EBUS was used in 26 of 56 patients. The median diameter of the lesions was 30 mm (interquartile range: 23-44 mm). Mean distance of the lesions from the pleura was 14.9 ± 14.6 mm. Mean procedure time was 20 ± 11.5 min. Mean registration error was 5.8 ± 1.5 mm. Mean navigation error was 1.2 ± 0.5 mm. The diagnostic yield of the procedure was 71.4% for peripheral lesions (non-small cell lung cancer = 23, small cell lung cancer = 3, benign diseases = 14). Pneumothorax occurred in only 1 patient (1.7%).
  
  
  CONCLUSIONS
  ENB with or without r-EBUS is a safe, efficient, and easily applied method for sampling of peripheral lung lesions, with high diagnostic yield independent of lesion size and location.
authors.affiliation: Bagcilar Chest Diseases and Thoracic Surgery Hospital, Istanbul, Turkey.
authors.forename: Guler
authors.initials: G
authors.lastname: Ozgul
authors.affiliation: Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
authors.forename: Erdogan
authors.initials: E
authors.lastname: Cetinkaya
authors.affiliation: Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Ozgul
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Abul
authors.affiliation: Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
authors.forename: Atayla
authors.initials: A
authors.lastname: Gencoglu
authors.affiliation: Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Kamiloglu
authors.affiliation: Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Gul
authors.affiliation: Pulmonary & Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: H Erhan
authors.initials: HE
authors.lastname: Dincer
keywords: Diagnostic yield; electromagnetic navigation bronchoscopy (ENB); peripheral lung lesion; transbronchial biopsy