Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance

Background: Bronchoscopy is a minimally invasive method for obtaining biopsies of lung lesions. If a biopsy is not obtained, more invasive methods such as transthoracic needle aspiration, video-assisted thoracoscopy, or diagnostic thoracotomy are required and they have a greater risk of complications. In addition, almost half of resected lesions are benign, and in screening programs, this proportion could be above 90%. Thus, the increased risk of complications from more invasive techniques must be weighed against the probability of finding benign lesions. A new, real-time electromagnetic guidance system for bronchoscopy has had promising results in obtaining lung biopsy in animal studies. Objective: The objective of this study was to determine the use and safety of this new guidance system in obtaining biopsies from 30 consecutive adults with isolated, peripheral lung lesions. Intervention: Anatomic landmarks and the target lesion were marked on digitized computed tomographic (CT) images and stored for later alignment with landmarks registered by the guidance system. With the patient on a magnetic navigation board, a sensor probe was advanced through the lungs and tracked in real-time on a monitor displaying the previously acquired, 3-dimensional CT images. Anatomic landmarks were registered with the system, which then automatically created a navigation scheme to approach the lesion precisely. After reaching the lesion, as confirmed with fluoroscopy and endobronchial ultrasound, biopsies were obtained. Results: Mean accuracy of target registration landmarks was within 3 mm of the values given on the CT images. Conclusive biopsies were obtained from 20 of 29 (69%) patients, and the procedure went as planned in 25. One biopsy-related pneumothorax and 3 cases of minor, self-limiting bleeding occurred. There were no serious complications. Conclusions: Real-time, electromagnetic-guided bronchoscopy, coupled with CT images, is a feasible and safe method for obtaining biopsies of peripheral lung lesions.