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S. Hatfield
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-025 - Electromagnetic Navigation Bronchoscopy in the Evaluation of Lung Lesions: The Carolinas Medical Center Experience (ID 2442)
09:30 - 09:30 | Author(s): S. Hatfield
- Abstract
Background:
Electromagnetic Navigation Bronchoscopy (ENB) is a relatively new minimally invasive bronchoscopic procedure that can be used to diagnose lung cancer, allowing bronchoscopists to (1) navigate towards peripheral lung lesions unreachable by a traditional bronchoscope, and (2) to utilize tools that can potentially obtain tissue samples large enough to perform advanced diagnostic and molecular testing. Here we share the experience of ENB at a large community-based hospital, aiming to better understand the diagnostic ability of ENB as well as possibly identify success factors for the biopsy methodology.
Methods:
Between September, 2012 and June, 2014, ENB was utilized in 138 cases to diagnose pulmonary lesions. Retrospective chart review was performed to access patient personal demographic information and disease-specific information. True positive diagnostic procedures were defined as those with a pathologically confirmed cancer diagnosis. True negative procedures were defined as those in which the lesions were not cancerous and had either resolved on radiological follow-up or have been stable over a period of 1 year. We assessed diagnostic yield percentages, lesion characteristics such as size and location, histological and staging characteristics of the tumor, outcomes of diagnostic tools, and size-tool correlation.
Results:
The ENB System carried an overall diagnostic yield of 75% with a sensitivity was 71.8% and specificity of 100%. 79% represented true positive results and 21% false negatives. Of the True Positives, 93% were non-small cell of which 73.6% were adenocarcinoma or had adenocarcinoma features. Of the latter, 82.1% of the adenocarcinomas diagnosed had enough tissue in the biopsy specimen for molecular testing. Of the negative results, 23% were later proven within 3-4 months of the initial biopsy and 77% after 3-4 months. The majority of cases attempted were stage I and II, with more success with lesions of larger tumor volume (greater than 500 mm[2]). Of the four tools used for biopsy sampling: lavage, brush, fine needle aspiration (FNA) and forceps, the brush had the highest true value percentage at 82.6%, followed by forceps at 80.7%. Lesions located in the right lung produced a greater percentage of true diagnoses with the right middle lobe giving an 87.5% yield while having the lowest percentage of false diagnoses at 12.5%. Risks for the procedure was 3.6% with 4 patients having pneumothorax and 1 patient with hemorrhage requiring intervention
Conclusion:
ENB can be successfully used to diagnose lung cancer in a community setting with a minimally invasive approach, and do so with reasonable accuracy and minimal risk. Moreover, tissue yields from this procedure were sufficient in over 80% of adenocarcinoma cases for molecular testing. Success factors include greater lesion size and the deployment of multiple diagnostic tools to enhance diagnostic yield. Further study is needed to determine other success factors.
