Background: Recent studies have described the promising method of electromagnetic navigated bronchoscopy (ENB) for diagnosis of peripheral solitary nodules. However, they require general anaesthesia or intravenous sedation. We wanted to know if ENB could be applied more easily in outpatients. Objectives: We prospectively evaluated the accuracy and the feasibility of ENB under local anaesthesia and nitrous oxide/oxygen inhalation as unique sedation in outpatients. Methods: After mapping time, the bronchoscopic procedure was carried out under local anaesthesia and nitrous oxide/oxygen inhalation with the unique help of the ENB to confirm the right position of the extended working channel before sampling. The primary end point was the accuracy of ENB and the secondary end point was the feasibility in outpatients. Results: Among 54 screened patients, 53 completed the study protocol. The overall diagnostic success rate to diagnose malignancy was 71.4% in tumours of 28 mm in median size. ENB classified correctly peripheral lesions according to malignity in 41 cases (30 cases of cancer, 11 benign diagnosis) and failed in 12 cases (1 probable lung metastasis, 11 lung cancers). All patients but 1 were dismissed 1 h after the procedure and the tolerance of the procedure was excellent in all cases except 2 (agitation and anxiety). In two cases (4%) a pneumothorax was recorded, 1 requiring drainage with a chest tube during a short hospitalisation. Conclusions: ENB under nitrous oxide/oxygen sedation seems to be an accurate and safe procedure. In our series, it allowed us to obtain the diagnosis in 71.4% of the tumours, with a good tolerance and an outpatient strategy.

Keywords:
Bronchoscopy, Electromagnetic navigated bronchoscopy, Lung cancer, Solitary pulmonary nodule
1.
Gould MK, Lillington GA: Strategy and cost in investigating solitary pulmonary nodules. Thorax 1998;53:32S–337S.
2.
Baaklini W, Reinoso M, Gorin A, et al: Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000;117:1049–1054.
3.
Paone G, Nicastri E, Lucantoni G, et al: Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. Chest 2005;128:3551–3557.
4.
Schreiber G, McCrory DC: Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest 2003;123:115S–128S.
5.
Swensen SJ, Jett JR, Sloan JA, et al: Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med 2002;165:508–513.
6.
Becker HD, Herth F, Ernst A, et al: Bronchoscopic biopsy of peripheral lung lesions under electromagnetic guidance: a pilot study. J Bronchology 2005;12:9–13.
7.
Eberhardt R, Anantham D, Herth F, et al: Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest 2007;131:1800–1805.
8.
Eberhardt R, Anantham D, Armin E, et al: Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 2007;176:36–41.
9.
Gildea TR, Mazzone PJ, Karnak D, et al: Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med 2006;174:982–989.
10.
Makris D, Scherpereel A, Leroy S, et al: Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions. Eur Respir J 2007;29:1187–1192.
11.
Schwarz Y, Mehta AC, Ernst A, et al: Electromagnetic navigation during flexible bronchoscopy. Respiration 2003;70:516–522.
12.
Schwarz Y, Greif J, Becker HD, et al: Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study. Chest 2006;129:988–994.
13.
Atassi K, Mangiapan C, Lasry S, et al: Prefixed equimolar nitrous oxide and oxygen mixture reduces discomfort during flexible bronchoscopy in adult patients: a randomized, controlled, double-blind trial. Chest 2005;128:863–868.
14.
Kurimoto N, Miyazawa T, Okimasa S, et al: Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest 2004;126:959–965.
15.
Shinagawa N, Yamazaki K, Onodera Y, et al: CT-guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation. Chest 2004;125:1138–1143.
16.
Shinagawa N, Yamazaki K, Onodera Y, et al: Factors related to diagnostic sensitivity using an ultrathin bronchoscope under CT guidance. Chest 2007;131:549–553.
17.
Wilson DS, Bartlett RJ: Improved diagnostic yield of bronchoscopy in a community practice: combination of electromagnetic navigation system and rapid on-site evaluation. J Bronchol 2007;14:227–232.
18.
Lamprecht B, Porsch P, Pirich C, et al: Electromagnetic navigation bronchoscopy in combination with PET-CT and rapid on-site cytopathologic examination for diagnosis of peripheral lung lesions. Lung 2009;187:55–59.
19.
Hatton MQF, Allen MB, Vathenen AS, et al: Does sedation help in fibreoptic bronchoscopy? BMJ 1994;309:1206–1207.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.