The Emerging Technique of Electromagnetic Navigation Bronchoscopy-Guided FNA of Peripheral Lung Lesions: Promising Results in 51 Patients
Florence L Loo, Rana S Hoda, Joby Zachariah, Kristin C Jensen. New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY; Veterans Affairs Palo Alto Health Care System and Stanford University Hospital, Stanford, CA
Background: Electromagnetic Navigation Bronchoscopy [(ENB), superDimension, Inc., Minneapolis, MN], is an emerging “GPS-like” system of bronchoscope used for pathologic evaluation of peripheral lung lesions [(PLL), outer 1/3 of chest] not visualized by standard bronchoscopy. Diagnostic yield of bronchoscopy for <2cm PLL is 14% (Am J Respir Crit Care Med. 2006;174:982). Compared to CT, ENB has less radiation and complications. Literature on fine needle aspiration (FNA) performed by ENB technique is scarce. Herein, we report our experience with ENB-FNA.
Design: Cases of PLL sampled by ENB at 2 institutions over 51-months (07/'07 to 09/'11) were reviewed. Details of ENB technique have been published (Ann Thorac Surg 2008;85:S797). Briefly, all patients had a thin-slice non-contrast CT to create a 3-dimensional re-construction of the bronchial tree and the PLL was marked. ENB was then used to guide bronchoscopic biopsy (BX) tools to the PLL. A FNA with rapid on-site cytologic evaluation (ROSE) was performed in all cases.
Results: 51 patients (pts) (M=42; F=9; age range: 49 to 88, mean: 66) were studied. 11/51 had a history of non-pulmonary malignancy. All cases had ROSE. PLL size ranged from 0.3cm-7.0cm (mean: 2.5cm). Overall, diagnostic tissue was obtained in 39/51 (76%) pts on ENB-FNA. Diagnostic yield of ENB-FNA was not significantly different by lesion sizes (73% for <2cm vs. 88% for >4cm, p-value=0.245). FNA diagnoses were: Malignant in 25 (24 primary and 1 metastatic); Benign/inflammatory (NEG), 19; Non-Diagnostic (ND), 7. The 24 primary cases included: adenocarcinoma (ACa), 15; squamous cell Ca, 4; non-small cell Ca, 3 and small cell Ca, 2. The 1 metastasis was urothelial Ca. 10/51 (20%) were false-negative (5 cases each from the NEG and ND category) and were considered ENB sampling error based on histologic follow-up. Sensitivity and specificity of ENB-FNA was 68% and 100%. Average time spent by the cytopathologist on-site was 45 min. Pneumothorax occurred in one pt.
Conclusions: In this series, evaluation of PLL by ENB-FNA has an overall sensitivity of 68% and specificity of 100% which is equivalent to other published series of ENB-FNA of PLL. Diagnostic yield for PLL <2cm is better compared to bronchoscopy and complication rate is lower compared to CT-guided FNA.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 53, Monday Morning