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Improving the investigation of suspected respiratory disease
P180 Electromagnetic navigation bronchoscopy as a diagnostic method in respiratory medicine: early clinical experiences
  1. S George,
  2. C Priegnitz,
  3. N Anduleit,
  4. W Randerath
  1. Krankenhaus Bethanien, Solingen, Germany

Abstract

Introduction and Objectives Electromagnetic navigation bronchoscopy (ENB) is approved for use as an adjunct to conventional bronchoscopy, aiding the diagnosis of peripheral lung lesions. It is a modern technique which improves bronchoscopic yield, thereby potentially preventing unnecessary operations or high-risk procedures. Our objective was to assess the use of this technique in regular clinical practice, and to identify factors which may influence its success.

Methods A retrospective data analysis of all ENB procedures carried out in a 120-bed speciality respiratory hospital in Solingen, Germany, between 2007 and 2011 revealed a total of 43 procedures. In each case, size and anatomical location of the tumour based on CT findings were noted. A positive result was documented if as a result of the procedure a clinical diagnosis could be reached.

Results ENB reached a clinical diagnosis in 15 of 43 patients (34.9%); eight malignant tumours, seven benign lesions, 28 left unclear. Of these 28, further investigations revealed a malignant process in nine patients, mostly by surgical interventions (n=6). 35 patients had previously had a failed diagnostic bronchoscopy. Of these patients, the addition of ENB allowed a diagnosis in 14 cases. 8 underwent an ENB directly upon assessment of the clinical data. The anatomical positioning of the lesion was without consequence for the diagnostic yield. The diagnostic yield increased significantly with the size of the lesion (<2 cm: 15%, 2–3 cm: 37%, >3 cm: 50%, p<0.001).

Conclusions ENB is a useful diagnostic method in the hands of a skilled interventional respiratory physician, particularly where conventional bronchoscopy has failed. Although the anatomical location does not affect the accuracy of the results, lesions over 2 cm in size are more likely to be amenable to this procedure. The overall diagnostic yield lies lower than those quoted in previous studies, so that selective use of this procedure should be considered.

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