Diagnostic accuracy and safety of electromagnetic navigation transthoracic needle biopsy under moderate sedation for the diagnosis of peripheral pulmonary lesions

BACKGROUND: Novel approaches using virtual computed tomography (CT) guidance, namely electromagnetic navigation transthoracic needle biopsy (EMN-TTNB), enable physicians to perform percutaneous lung biopsies. However, there are very few studies on the clinical experiences of EMN-TTNB, and in previous studies, the procedure was usually performed under deep sedation. This study aimed to determine the diagnostic accuracy and safety of EMN-TTNB under moderate sedation. METHODS: We conducted a retrospective analysis of patients who underwent EMN-TTNB under moderate sedation between May 2021 and November 2022 at Hallym University Dongtan Sacred Heart Hospital in South Korea. Moderate sedation was achieved with midazolam injection in the bronchoscopy room using the Veran SPiNperc EM guidance system (Veran Medical, St Louis, MO, USA). Clinical data were collected by review of medical records, and diagnostic accuracy and safety were calculated. RESULTS: Thirty-two patients were enrolled (mean age 70.8±11.1 years); 56.3% were male. The mean size of the pulmonary lesions was 36.9±17.4 mm, and the median (interquartile range) distance from the pleura was 15.5 (0.0–30.0) mm. The diagnostic accuracy of EMN-TTNB was 75.0% (21/28), excluding four indeterminate cases. Fourteen patients (50.0%, 14/28) had true-positive and seven patients (25.0%, 7/28) had true-negative lesions. There were no severe adverse reactions such as pneumothorax, respiratory failure, or death, except one case of hemoptysis. CONCLUSIONS: EMN-TTNB under moderate sedation showed an acceptable diagnostic accuracy and good safety profile. The new technology allows physicians to perform percutaneous lung biopsies without the intervention of a radiologist or anesthesiologist.