Electromagnetic Navigation Bronchoscopy with Multimodalities for Peripheral Pulmonary Nodules: A Prospective, Multicenter, Cohort Study

Y. Li^a (Dr), W. Chen^b (Dr), F. Xie^a (Dr), R. Huang^c (Dr), X. Zheng^a (Dr), X. Liu^d (Dr), Y. Xiao^e (Dr), L. Cao^f (Prof), M. Ke^c (Prof), S. Wu^d (Prof), Y. Hu^e (Prof), J. Sun*^a (Prof)

^a Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, CHINA ; ^b Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CHINA ; ^c The Second Affiliated Hospital of Xiamen medical college, Xiamen, CHINA ; ^d Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, CHINA ; ^e Department of Respiratory, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHINA ; ^f Xiangya Hospital Central South University, Changsha, CHINA

* xkyyjysun@163.com

Ying Li, Wei Chen, Fangfang Xie and Rui Huang contributed equally to this article.

Background: We reported a real-world application strategy of a novel electromagnetic navigation bronchoscopy (ENB) system for peripheral pulmonary nodules, in order to find the optimal diagnostic modalities based on lesions characteristics and individual operational preference of clinicians.

Methods: This prospective, cohort study enrolled consecutive patients adopted ENB between March 2019 and August 2021 at six clinical centers. ENB was flexibly applicated with different modalities. The primary endpoint was the diagnostic yield of ENB based on at least 6-month follow up. Procedural details and complications were also recorded.

Results: A total of 479 subjects with 479 nodules were enrolled in this study. The average lesion size was 20.6±6.0 mm. The overall diagnostic yield of ENB bronchoscopy was 79.7% (382/479). The sensitivity for malignant nodules was 81.6% (298/365), and for benign nodules was 73.7% (84/114). The diagnosis yield of different guided strategies showed no significant difference. Univariate analysis identified lesion size, lesion property, CT-bronchus sign, rEBUS position, rapid-on-site evaluation (ROSE) were predictors associated with diagnostic yield. Lobar location, lesion nature, anesthesia, bronchoscopes, guided sheath, fluoroscopy were not identified to be associated with bronchoscopic diagnostic yield. Multivariate analysis showed that lesion size, lesion property and CT-bronchus sign were correlated with diagnosis yield. Complications occurred in 15 moderate bleeding during bronchoscopy and 1 pneumothorax which required tube drainage.

Conclusion: ENB is an efficient diagnostic tool for peripheral pulmonary lesions.

Disclosure of funding source(s): none