Cone-Beam Computed Tomography-Guided Electromagnetic Navigation for Peripheral Lung Nodules

Fayez Kheir; Sanket R Thakore; Juan Pablo Uribe Becerra; Mohammad Tahboub; Rahul Kamat; Ramsy Abdelghani; Sebastian Fernandez-Bussy; Upendra R Kaphle; Adnan Majid

doi:10.1159/000510763

Cone-Beam Computed Tomography-Guided Electromagnetic Navigation for Peripheral Lung Nodules

Respiration. 2021;100(1):44-51. doi: 10.1159/000510763. Epub 2021 Jan 5.

Authors

Fayez Kheir^{1

2}, Sanket R Thakore^{1

3}, Juan Pablo Uribe Becerra², Mohammad Tahboub¹, Rahul Kamat¹, Ramsy Abdelghani^{1

2}, Sebastian Fernandez-Bussy⁴, Upendra R Kaphle⁵, Adnan Majid⁶

Affiliations

¹ Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
² Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
³ Division of Interventional Pulmonary, Department of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, Connecticut, USA.
⁴ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.
⁵ Division of Pulmonary and Critical Care, Kaiser Permanente Roseville and Sacramento Medical Center, Roseville, California, USA.
⁶ Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, amajid@bidmc.harvard.edu.

PMID: 33401270
DOI: 10.1159/000510763

Abstract

Background: Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive technology for the diagnosis of peripheral pulmonary nodules. However, ENB is limited by the lack of real-time confirmation of various biopsy devices. Cone-beam computed tomography (CBCT) could increase diagnostic yield by allowing real-time confirmation to overcome the inherent divergence of nodule location.

Objectives: The aim of this study was to assess the diagnostic yield of ENB plus CBCT as compared with ENB alone for biopsy of peripheral lung nodules.

Method: We conducted a retrospective study of patients undergoing ENB before and after the implementation of CBCT. Data from 62 consecutive patients with lung nodules located in the outer two-thirds of the lung who underwent ENB and combined ENB-CBCT were collected. Radial endobronchial ultrasound was used during all procedures as well. Diagnostic yield was defined as the presence of malignancy or benign histological findings that lead to a specific diagnosis.

Results: Thirty-one patients had ENB-CBCT, and 31 patients had only ENB for peripheral lung lesions. The median size of the lesion for the ENB-CBCT group was 16 (interquartile range (IQR) 12.6-25.5) mm as compared to 21.5 (IQR 16-27) mm in the ENB group (p = 0.2). In the univariate analysis, the diagnostic yield of ENB-CBCT was 74.2% and ENB 51.6% (p = 0.05). Following multivariate regression analysis adjusting for the size of the lesion, distance from the pleura, and presence of bronchus sign, the odds ratio for the diagnostic yield was 3.4 (95% CI 1.03-11.26, p = 0.04) in the ENB-CBCT group as compared with ENB alone. The median time for the procedure was shorter in patients in the ENB-CBCT group (74 min) than in those in the ENB group (90 min) (p = 0.02). The rate of adverse events was similar in both groups (6.5%, p = 0.7).

Conclusions: The use of CBCT might increase the diagnostic yield in ENB-guided peripheral lung nodule biopsies. Future randomized clinical trials are needed to confirm such findings.

Keywords: Cone-beam computed tomography; Electromagnetic navigation; Peripheral lung nodules.

MeSH terms

Aged
Bronchoscopy* / adverse effects
Bronchoscopy* / methods
Cone-Beam Computed Tomography / methods*
Female
Humans
Image-Guided Biopsy* / adverse effects
Image-Guided Biopsy* / instrumentation
Image-Guided Biopsy* / methods
Lung / diagnostic imaging*
Lung Neoplasms / diagnosis*
Lung Neoplasms / epidemiology
Magnets
Male
Middle Aged
Multiple Pulmonary Nodules / pathology*
Retrospective Studies
Solitary Pulmonary Nodule / pathology*
United States / epidemiology