The emerging technique of electromagnetic navigation bronchoscopy-guided fine-needle aspiration of peripheral lung lesions: Promising results in 50 lesions

BACKGROUND Literature on the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) with ENB-guided fine-needle aspiration (ENB-FNA) in peripheral lung lesions (PLLs) that measure <= 2 cm is scarce. Data on the diagnostic yield of ENB-FNA for PLLs when performed in conjunction with positron emission tomography-computed tomography (PET-CT), rapid on-site evaluation (ROSE), ENB-guided bronchial brushing (ENB-BB), and ENB-guided transbronchial biopsy (ENB-TBx) is also limited. In this study, the authors evaluated their experience with ENB-FNA performed in conjunction with all 4 modalities: PET-CT, ROSE, ENB-BB, and ENB-TBx. METHODS ENB-FNA and other tests over a 2-year-period (from July 2011 to July 2013) were retrospectively reviewed. RESULTS There were 50 PLLs from 40 patients, and the mean lesion size (available for 45 PLLs) was 2.6 cm: these included 24 PLLs that measured <= 2 cm and 21 PLLs that measured > 2.0 cm. The ENB-FNA diagnosis was malignant in 17 lesions, atypical in 1 lesion, benign in 31 lesions, and nondiagnostic in 1 lesion. On the basis of lesion size, the diagnostic yield of PLLs was 87% in lesions <= 2 cm and 100% in lesions > 2.0 cm (P = 0.5; not significant). Follow-up available in 49 of 50 PLLs from 39 patients had an overall diagnostic yield of 94% for ENB-FNA. The diagnostic yield of PET-CT (available in 31 of 50 PLLs) and of ENB-BB and ENB-TBx (available in 40 of 50 PLLs) in conjunction with ENB-FNA was 61% and 95%, respectively. ROSE was performed in 46 of 50 PLLs: the overall sensitivity of ROSE and ENB-FNA was 85% and 89.4%, respectively, and their specificity was 96.5% and 100%, respectively. There were no procedure-related complications. CONCLUSIONS The high overall diagnostic yield of 94% and fewer complications make ENB-FNA a useful modality for the assessment of PLLs. In this study, ROSE was useful, whereas PET-CT, ENB-BB, and ENB-TBx were not useful in the evaluation of PLLs. Cancer (Cancer Cytopathol) 2014;122:191-199. (c) 2013 American Cancer Society.