Evaluation and experience of a newly established national navigational bronchoscopy service in Scotland

F. Millar^a (Dr), S. Giavedoni^a (Dr), J. Mccafferty^a (Dr), A. Marshall*^a (Dr)

^a NHS Lothian, Edinburgh, UNITED KINGDOM

* adam.marshall@nhslothian.scot.nhs.uk

Background:

Electromagnetic navigation bronchoscopy (ENB) is an emerging bronchoscopic technique allowing access to peripheral lung lesions not targetable with conventional flexible bronchoscopy. This technique was not previously available in Scotland. We report our initial experience of ENB in a UK teaching hospital servicing patients across Scotland.

Methods:

We evaluated diagnostic performance and safety outcomes from the first 63 cases of ENB from a newly established national ENB service. Lesion demographics were obtained from pre-procedure computed tomography. All procedures were performed on an outpatient basis under conscious sedation using an Olympus 1T bronchoscope and the Medtronic superDimension^TM Navigation System. Sampling techniques including biopsy, needle aspiration, endobronchial brushing and endobronchial washing were performed at the discretion of the operator.

Results:

ENB procedures were carried out on patients referred from across Scotland. Two cases were excluded from analysis due to failed registration of the navigation system and unknown final diagnosis. The overall diagnostic rate was 39/61 (63.1%). Of note, five cases designated as false negatives showed evidence of cellular atypia, prompting further intervention in the form of surgical resection or CT guided biopsy. Diagnostic accuracy correlated with lesion size (<30mm 50% vs >30mm 68.75%, p=0.1778) and lesion location (middle third 67.9% vs outer third 59.4%, p=0.5949), however the use of radial EBUS (rEBUS) did not (without rEBUS 62.5% vs with rEBUS 63.1%, p>0.9999). This is likely explained by more challenging case selection when using rEBUS as demonstrated by significantly smaller lesions size (without rEBUS 39.2+/-14.2mm vs with rEBUS 29.5+/-13.5mm, p=0.0081). The complication rate was low (Pneumothorax 1/63 (1.6%) and moderate bleeding 1/63 (1.6%)).

Conclusions:

These data show that we have successfully established an ENB service with a relatively high diagnostic yield and low complication rate. Ongoing experience and learning are expected to lead to further improvements in these parameters.

Disclosure of funding source(s): none