Outcomes A Newly Established Electromagnetic Navigation Bronchoscopy Service in the Middle East



Mateen Uzbeck1, *, Zaid Zoumot1, Irfan Shafiq1, Mahmoud El-Kaissi2, Redha Souilamas3, Ali Saeed Wahla1
1 Cleveland Clinic Abu Dhabi, Respiratory Institute, United Arab Emirates
2 Cleveland Clinic Abu Dhabi, Imaging Institute, United Arab Emirates
3 Cleveland Clinic Abu Dhabi, Thoracic Surgery, United Arab Emirates

Abstract

Aims:

Electromagnetic navigation bronchoscopy (EMNB) is a useful tool for the bronchoscopist to target peripheral pulmonary lesions. It has a well-established efficacy and safety profile; however, there are no studies describing its utility in a Middle Eastern population. In this paper, we describe the efficacy and safety outcomes of a newly established EMNB service.

Background:

The diagnosis of peripheral pulmonary lesions presents a significant challenge to the bronchoscopist, especially in the era of increased thoracic imaging with computerized tomography (CT) scans. EMNB is a relatively novel technique that utilizes an image-guided localization system akin toglobal positioning satellite (GPS) technology, offering the bronchoscopist an accurate navigational pathway to sample peripheral pulmonary targets.

Objective:

We present our initial experience of performing EMNB and report our diagnostic and safety outcomes with EMN bronchoscopy.

Method:

We conducted a retrospective review of the medical notes of all patients booked for EMNB during May 2015 to December 2019 at our tertiary care center using the electronic medical record system.

Results and Discussion:

Fifty-five patients were scheduled for EMNB, and 47 patients (24 males, 23 females) had EMNB guided sampling between May 2015 and December 2019. The median age of the patients was 61 years (IQR 49.5-74.3). A bronchus sign was present on the CT chest in 29 (61.7%) cases. Thirty-one (66%) patients had positive EMNB guided samples. There was a weak correlation between the lesion size and the positive EMNB guided sampling (r: 0.34). Twenty-one of 29 (72%) patients with a positive bronchus signs had positive EMNB guided samples, compared to 10/18 (56%) patients without a bronchus signs; however, the difference was not statistically significant (p-value 0.335). When we compared the presence or absence of rapid onsite examination of cytopathological specimens (ROSE) during the procedure, a trend favoring the presence of ROSE could be seen, but this was statistically non-significant (p-value 0.078). In our series, one patient with pre-existing triple vessel coronary artery disease developed an inferior wall ST-segment elevation myocardial infarction (STEMI), likely secondary to spasm. This patient recovered completely and was discharged from the hospital.

Conclusion:

Our study demonstrates that EMNB can be safely performed in a middle eastern population with results similar to those reported in major international studies. The highest diagnostic yield was in patients with a bronchus sign on CT scan, and combining EMNB with ROSE can increase the chances of having a positive diagnostic bronchoscopy. However, patients and physicians need to be aware of the need to follow patients with negative biopsies to ensure that false negatives are picked up.

Keywords: Electromagnetic navigation bronchoscopy, Peripheral pulmonary lesions, Radial Electrobronchial Ultrasound (EBUS), Fluoroscopy, Rapid onsite cytologic examination.


Abstract Information


Identifiers and Pagination:

Year: 2022
Volume: 16
Publisher Id: EA-TORMJ-2021-19

Article History:

Electronic publication date: 13/4/2022
Collection year: 2022

© 2022 Uzbeck et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Cleveland Clinic Abu Dhabi, Respiratory Institute, United Arab Emirates; E-mail: UzbeckM@ClevelandClinicAbuDhabi.ae