Electromagnetic navigation bronchoscopy as an adjunct diagnostic tool in the Danish lung cancer diagnostic pathway: an initial retrospective single centre series

BACKGROUND: The performance of electromagnetic navigation bronchoscopy (ENB) is reported with substantial variation, which may question its clinical usefulness. However, ENB may hold its true value when used as an additional minimal invasive diagnostic option before potential surgery in selected diagnostically challenging patients where traditional diagnostic methods have failed. We evaluated the safety and performance of ENB when used as an adjunct diagnostic tool in the Danish lung cancer diagnostic pathway (DLCDP) and its ability to reduce surgical diagnostic procedures. METHODS: A retrospective study was performed on eighty-two consecutive patients at Odense University Hospital from June 2016 to March 2018 with diagnostically challenging pulmonary lesions referred for ENB as an adjunct diagnostic procedure under the DLCDP. Patients with benign or inconclusive ENB pathology were either referred for further biopsies, surgery or repeated computer tomography (CT) scans for surveillance purposes. RESULTS: Eighty-one ENB procedures were performed in 80 patients. In 87.7% of the cases previous diagnostic methods had been unsuccessful. The mean target diameter was 1.55 cm and the average follow-up duration was 11 months. The diagnostic accuracy was 75%, while the diagnostic yield/sensitivity, negative predictive value and negative likelihood ratio was 51%, 67% and 0.49, respectively. No pneumothoraces and only one intrapulmonary haemorrhage was recorded, which was managed conservatively. The learning curve revealed an increase in diagnostic accuracy from 67.5% to 82.9% when comparing the first 40 ENB procedures with the last 41 procedures, however, this was not statistically significant (p-value: 0.11). CONCLUSIONS: ENB was found to be a safe procedure with an acceptable diagnostic accuracy and yield in highly selected diagnostically challenging patients. The introduction of ENB carried a notable learning curve but proved to be a valuable adjunct diagnostic option in the DLCDP, which may help to reduce the number of potentially unnecessary or harmful surgical procedures in frail patients.