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. © 2013 American Cancer Society. The electromagnetic navigation system is an image‐guided localization device for sampling peripheral lung lesions. The overall diagnostic yield of electromagnetic navigation bronchoscopy‐guided fine‐needle aspiration is 94% based on follow‐up and is independent of lesion size. Rapid on‐site evaluation is the only modality that positively affects diagnostic yield of electromagnetic navigation bronchoscopy‐guided fine‐needle aspiration.