Improved diagnostic yield of bronchoscopy in a community practice

Combination of electromagnetic navigation system and rapid on-site evaluation

David S. Wilson, Rebecca Ellis

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

BACKGROUND: Several techniques are currently available to improve the diagnostic yield of routine flexible bronchoscopy. In the present study, we have evaluated the contribution of 2 methods used in our community practice: electromagnetic navigation (EMN, superDimension Ltd, Herzliya, Israel) and rapid on-site cytologic evaluation of obtained tissue samples. The main purpose of the study was to determine the percentage of patients that had a malignant diagnosis or a plausible nonmalignant diagnosis on the day of the procedure. MATERIALS AND METHODS: Consecutive patients that had EMN-assisted biopsy procedures between June 2005 and July 2006 were studied. Patient records were retrospectively reviewed by the author to determine performance of above-mentioned system, diagnostic yield of flexible bronchoscopy, and adverse events. The majority of patients were followed-up for confirmation of final diagnosis and/or for treatment. RESULTS: A total of 248 patients were included. Mean size of the targeted peripheral lesions and lymph nodes was 2.1±1.4 (SD)cm and 1.8±0.9 (SD)cm, respectively. Mean follow-up period was 6±5 (SD) months. The majority (51%) of the peripheral lesions were in the upper lung lobes. EMN was successful, and tissue samples were obtained from 96% of the peripheral lesions, and 94.3% of the lymph nodes. On the day of the procedure, 161/248 (65%) patients received a definitive malignant or plausible nonmalignant diagnosis. With additional clinical follow-up, 12 patients (5%) with a nonmalignant diagnosis on the day of the procedure were confirmed as having no disease, 8 patients (3%) were confirmed as having malignant disease, and 67 patients (27%) remained inconclusive due to lack of clinical follow-up information, leading to total of 173/248 (70%) of diagnostic cases. Thus, when all inconclusive cases are treated as nondiagnostic, the yield is 70%, and when the estimate of the percent of diagnostic and nondiagnostic cases from the observed data is applied to the inconclusive cases, the estimate of diagnostic yield is 86%. Eight complications occurred; moderate bleeding (3), pneumothorax (3), hematoma (1), and pneumonia with exacerbation of chronic obstructive pulmonary disease (1). None of the complications were related to use of the EMN system. CONCLUSIONS: EMN is safe and provides a new noninvasive diagnostic option for smaller peripheral lung lesions and enlarged mediastinal lymph nodes. In a community based practice, EMN in combination with rapid on-site cytologic evaluation can provide for patients with a lung lesion, diagnosis in an expeditious and effective manner.

Original languageEnglish (US)
Pages (from-to)227-232
Number of pages6
JournalJournal of Bronchology
Volume14
Issue number4
DOIs
StatePublished - Oct 2007
Externally publishedYes

Fingerprint

Electromagnetic Phenomena
Bronchoscopy
Lymph Nodes
Lung
Pneumothorax
Israel
Hematoma
Chronic Obstructive Pulmonary Disease
Pneumonia
Hemorrhage
Biopsy

Keywords

  • Bronchoscopy
  • Community hospital
  • Diagnostic imaging
  • Electromagnetic navigation bronchoscopy (ENB)
  • Lung cancer
  • Mediastinal lymph nodes
  • Rapid on-site cytologic evaluation (ROSE)
  • Solitary pulmonary nodule
  • SuperDimension

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

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title = "Improved diagnostic yield of bronchoscopy in a community practice: Combination of electromagnetic navigation system and rapid on-site evaluation",
abstract = "BACKGROUND: Several techniques are currently available to improve the diagnostic yield of routine flexible bronchoscopy. In the present study, we have evaluated the contribution of 2 methods used in our community practice: electromagnetic navigation (EMN, superDimension Ltd, Herzliya, Israel) and rapid on-site cytologic evaluation of obtained tissue samples. The main purpose of the study was to determine the percentage of patients that had a malignant diagnosis or a plausible nonmalignant diagnosis on the day of the procedure. MATERIALS AND METHODS: Consecutive patients that had EMN-assisted biopsy procedures between June 2005 and July 2006 were studied. Patient records were retrospectively reviewed by the author to determine performance of above-mentioned system, diagnostic yield of flexible bronchoscopy, and adverse events. The majority of patients were followed-up for confirmation of final diagnosis and/or for treatment. RESULTS: A total of 248 patients were included. Mean size of the targeted peripheral lesions and lymph nodes was 2.1±1.4 (SD)cm and 1.8±0.9 (SD)cm, respectively. Mean follow-up period was 6±5 (SD) months. The majority (51{\%}) of the peripheral lesions were in the upper lung lobes. EMN was successful, and tissue samples were obtained from 96{\%} of the peripheral lesions, and 94.3{\%} of the lymph nodes. On the day of the procedure, 161/248 (65{\%}) patients received a definitive malignant or plausible nonmalignant diagnosis. With additional clinical follow-up, 12 patients (5{\%}) with a nonmalignant diagnosis on the day of the procedure were confirmed as having no disease, 8 patients (3{\%}) were confirmed as having malignant disease, and 67 patients (27{\%}) remained inconclusive due to lack of clinical follow-up information, leading to total of 173/248 (70{\%}) of diagnostic cases. Thus, when all inconclusive cases are treated as nondiagnostic, the yield is 70{\%}, and when the estimate of the percent of diagnostic and nondiagnostic cases from the observed data is applied to the inconclusive cases, the estimate of diagnostic yield is 86{\%}. Eight complications occurred; moderate bleeding (3), pneumothorax (3), hematoma (1), and pneumonia with exacerbation of chronic obstructive pulmonary disease (1). None of the complications were related to use of the EMN system. CONCLUSIONS: EMN is safe and provides a new noninvasive diagnostic option for smaller peripheral lung lesions and enlarged mediastinal lymph nodes. In a community based practice, EMN in combination with rapid on-site cytologic evaluation can provide for patients with a lung lesion, diagnosis in an expeditious and effective manner.",
keywords = "Bronchoscopy, Community hospital, Diagnostic imaging, Electromagnetic navigation bronchoscopy (ENB), Lung cancer, Mediastinal lymph nodes, Rapid on-site cytologic evaluation (ROSE), Solitary pulmonary nodule, SuperDimension",
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T1 - Improved diagnostic yield of bronchoscopy in a community practice

T2 - Combination of electromagnetic navigation system and rapid on-site evaluation

AU - Wilson, David S.

AU - Ellis, Rebecca

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N2 - BACKGROUND: Several techniques are currently available to improve the diagnostic yield of routine flexible bronchoscopy. In the present study, we have evaluated the contribution of 2 methods used in our community practice: electromagnetic navigation (EMN, superDimension Ltd, Herzliya, Israel) and rapid on-site cytologic evaluation of obtained tissue samples. The main purpose of the study was to determine the percentage of patients that had a malignant diagnosis or a plausible nonmalignant diagnosis on the day of the procedure. MATERIALS AND METHODS: Consecutive patients that had EMN-assisted biopsy procedures between June 2005 and July 2006 were studied. Patient records were retrospectively reviewed by the author to determine performance of above-mentioned system, diagnostic yield of flexible bronchoscopy, and adverse events. The majority of patients were followed-up for confirmation of final diagnosis and/or for treatment. RESULTS: A total of 248 patients were included. Mean size of the targeted peripheral lesions and lymph nodes was 2.1±1.4 (SD)cm and 1.8±0.9 (SD)cm, respectively. Mean follow-up period was 6±5 (SD) months. The majority (51%) of the peripheral lesions were in the upper lung lobes. EMN was successful, and tissue samples were obtained from 96% of the peripheral lesions, and 94.3% of the lymph nodes. On the day of the procedure, 161/248 (65%) patients received a definitive malignant or plausible nonmalignant diagnosis. With additional clinical follow-up, 12 patients (5%) with a nonmalignant diagnosis on the day of the procedure were confirmed as having no disease, 8 patients (3%) were confirmed as having malignant disease, and 67 patients (27%) remained inconclusive due to lack of clinical follow-up information, leading to total of 173/248 (70%) of diagnostic cases. Thus, when all inconclusive cases are treated as nondiagnostic, the yield is 70%, and when the estimate of the percent of diagnostic and nondiagnostic cases from the observed data is applied to the inconclusive cases, the estimate of diagnostic yield is 86%. Eight complications occurred; moderate bleeding (3), pneumothorax (3), hematoma (1), and pneumonia with exacerbation of chronic obstructive pulmonary disease (1). None of the complications were related to use of the EMN system. CONCLUSIONS: EMN is safe and provides a new noninvasive diagnostic option for smaller peripheral lung lesions and enlarged mediastinal lymph nodes. In a community based practice, EMN in combination with rapid on-site cytologic evaluation can provide for patients with a lung lesion, diagnosis in an expeditious and effective manner.

AB - BACKGROUND: Several techniques are currently available to improve the diagnostic yield of routine flexible bronchoscopy. In the present study, we have evaluated the contribution of 2 methods used in our community practice: electromagnetic navigation (EMN, superDimension Ltd, Herzliya, Israel) and rapid on-site cytologic evaluation of obtained tissue samples. The main purpose of the study was to determine the percentage of patients that had a malignant diagnosis or a plausible nonmalignant diagnosis on the day of the procedure. MATERIALS AND METHODS: Consecutive patients that had EMN-assisted biopsy procedures between June 2005 and July 2006 were studied. Patient records were retrospectively reviewed by the author to determine performance of above-mentioned system, diagnostic yield of flexible bronchoscopy, and adverse events. The majority of patients were followed-up for confirmation of final diagnosis and/or for treatment. RESULTS: A total of 248 patients were included. Mean size of the targeted peripheral lesions and lymph nodes was 2.1±1.4 (SD)cm and 1.8±0.9 (SD)cm, respectively. Mean follow-up period was 6±5 (SD) months. The majority (51%) of the peripheral lesions were in the upper lung lobes. EMN was successful, and tissue samples were obtained from 96% of the peripheral lesions, and 94.3% of the lymph nodes. On the day of the procedure, 161/248 (65%) patients received a definitive malignant or plausible nonmalignant diagnosis. With additional clinical follow-up, 12 patients (5%) with a nonmalignant diagnosis on the day of the procedure were confirmed as having no disease, 8 patients (3%) were confirmed as having malignant disease, and 67 patients (27%) remained inconclusive due to lack of clinical follow-up information, leading to total of 173/248 (70%) of diagnostic cases. Thus, when all inconclusive cases are treated as nondiagnostic, the yield is 70%, and when the estimate of the percent of diagnostic and nondiagnostic cases from the observed data is applied to the inconclusive cases, the estimate of diagnostic yield is 86%. Eight complications occurred; moderate bleeding (3), pneumothorax (3), hematoma (1), and pneumonia with exacerbation of chronic obstructive pulmonary disease (1). None of the complications were related to use of the EMN system. CONCLUSIONS: EMN is safe and provides a new noninvasive diagnostic option for smaller peripheral lung lesions and enlarged mediastinal lymph nodes. In a community based practice, EMN in combination with rapid on-site cytologic evaluation can provide for patients with a lung lesion, diagnosis in an expeditious and effective manner.

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KW - Mediastinal lymph nodes

KW - Rapid on-site cytologic evaluation (ROSE)

KW - Solitary pulmonary nodule

KW - SuperDimension

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