Objective: To evaluate the diagnostic value and safety of electromagnetic navigation bronchoscopy real-time guidance lung biopsy (ENB-guided TBLB) of small peripheral lung lesions (diameter < 3 cm).
Methods: Patients were selected by small peripheral pulmonary lesions (diameter < 3 cm) on thoracic CT in our hospital between September 1, 2011 and May 30, 2012. ENB-guided TBLB was performed by flexible bronchoscope, while fluoroscopy-guided lung biopsy was performed as a control. Then the diagnostic yield of ENB-guided and fluoroscopy-guided lung biopsy was compared. The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 12 month follow-up until clinical cure being confirmed. The intraoperative and postoperative complications were recorded.
Results: Seventeen patients (11 males, 6 females) with 20 small peripheral pulmonary lesions all underwent ENB- guided TBLB. The patients' average age was (53 ± 14) yrs , and the lesions' average diameter was (1.8 ± 0.7) cm. Eleven patients finally received surgical resection, while other 6 patients received medical treatment and follow-up for more than 12 months to achieve clinical cure. Pathologic results showed that the diagnostic yield of ENB group was 80.0% (16/20) and that of the fluoroscopy group was 45.0% (9/20), the difference between the 2 groups being statistically significant (χ² = 5.227, P = 0.048). Subgroup analysis showed that, if the lesion diameter was 2-3 cm, the diagnostic yield between the 2 groups had no statistical difference (χ² = 0.000, P = 1.000), but if the lesion diameter was < 2 cm, the diagnostic yield of the 2 groups was statistically different (χ(2) = 8.224, P = 0.012). In the ENB method, the diagnostic yield between the diameter of 2-3 cm group and the < 2 cm group had no statistical difference (χ² = 0.208, P = 1.000). Analysis of the diagnostic yield of different navigation plan CT graph layer thickness showed that, the 1 cm group was higher than the 2 cm group (χ² = 6.111, P = 0.026). The diagnostic yield of lesions with "air bronchogram" was higher than that of lesions without "air bronchogram" (χ² = 6.111, P = 0.026).
Conclusion: Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for small peripheral pulmonary lesions is safe, and has higher diagnostic rate.