Background: Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and safety is required for comparison to other sampling modalities. Objectives: To describe ENB's yield and safety profile. Methods: The MEDLINE and EMBASE databases were systematically searched for studies reporting ENB's yield for peripheral lung lesions. Two independent investigators extracted data and rated each study on a scale of methodological quality. Clearly defined performance outcomes were reconstructed and meta-analyzed. Subgroup analysis and meta-regression were used to identify possible sources of study heterogeneity. Results: A total of 15 trials were included (1,033 lung nodules). A positive and definitive diagnosis was obtained after 64.9% of all ENB procedures (95% CI 59.2-70.3). Overall diagnostic accuracy was 73.9% (95% CI 68.0-79.2). Sensitivity to detect cancer was 71.1% (95% CI 64.6-76.8), with a negative predictive value of 52.1% (95% CI 43.5-60.6). Pneumothorax occurred in 3.1% of patients, requiring chest tube drainage in 1.6% of these cases. Original trials identified 6 variables associated with higher ENB yields: nodule location in the upper or middle lobes, nodule size, lower registration error, presence of a bronchus sign on CT imaging, combined use of an ultrasonic radial probe, and catheter suctioning as a sampling technique. Heterogeneity exploration revealed that studies using general anesthesia or rapid on-site cytological evaluation reported better yields. Conclusions: ENB is effective and particularly safe. Prospective studies are needed to clarify the role of several variables conditioning the yield of this technique.

Keywords:
Electromagnetic navigation bronchoscopy, Peripheral lung lesions, Solitary pulmonary nodule
1.
Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, et al: Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (ed 2). Chest 2007;132(3 suppl):108S-130S.
2.
Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P: Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000;117:1049.
3.
Becker HD, Herth F, Ernst A, Schwarz Y: Bronchoscopic biopsy of peripheral lung lesions under electromagnetic guidance: a pilot study. J Bronchology Interv Pulmonol 2005;12:9.
4.
Wang Memoli JS, Nietert PJ, Silvestri GA: Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest 2012;142:385-393.
5.
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J: The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25.
6.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem 2003;49:7-18.
7.
DerSimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-188.
8.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.
9.
Duval S, Tweedie R: Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455-463.
10.
Weiser TS, Hyman K, Yun J, Litle V, Chin C, Swanson SJ: Electromagnetic navigational bronchoscopy: a surgeon's perspective. Ann Thoracic Surg 2008;85:S797-S801.
11.
Karnak D, Çiledağ A, Ceyhan K, et al: Electromagnetic navigation diagnostic bronchoscopy for peripheral lung lesions and mediastinal lymph nodes: first results. Turk Toraks Dergisi 2011;12:51
12.
Seijo LM, Bastarrika G, Lozano MD, Zulueta JJ: Preliminary experience with the use of electromagnetic navigation for the diagnosis of peripheral pulmonary nodules and enlarged mediastinal lymph nodes (in Spanish). Arch Bronconeumol 2007;43:460-463.
13.
Hautmann H, Schneider A, Pinkau T, Peltz F, Feussner H: Electromagnetic catheter navigation during bronchoscopy: validation of a novel method by conventional fluoroscopy. Chest 2005;128:382-387.
14.
Gildea TR, Mazzone PJ, Karnak D, et al: Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med 2006;174:982.
15.
Schwarz Y, Greif J, Becker HD, et al: Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images. Chest 2006;129:988.
16.
Makris D, Scherpereel A, Leroy S, Bouchindhomme B, Faivre J-B, Remy J, et al: Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions. Eur Respir J 2007;29:1187-1192.
17.
Eberhardt R, Anantham D, Herth F, Feller-Kopman D, Ernst A: Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest 2007;131:1800.
18.
Eberhardt R, Anantham D, Ernst A, Feller-Kopman D, Herth F: Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 2007;176:36.
19.
Wilson DS, Bartlett RJ: Improved diagnostic yield of bronchoscopy in a community practice: combination of electromagnetic navigation system and rapid on-site evaluation. J Bronchology Interv Pulmonol 2007;14:227.
20.
Bertoletti L, Robert A, Cottier M, Chambonniere ML, Vergnon JM: Accuracy and feasibility of electromagnetic navigated bronchoscopy under nitrous oxide sedation for pulmonary peripheral opacities: an outpatient study. Respiration 2009;78:293-300.
21.
Eberhardt R, Morgan RK, Ernst A, Beyer T, Herth FJ: Comparison of suction catheter versus forceps biopsy for sampling of solitary pulmonary nodules guided by electromagnetic navigational bronchoscopy. Respiration 2009;79:54-60.
22.
Lamprecht B, Porsch P, Pirich C, et al: Electromagnetic navigation bronchoscopy in combination with PET-CT and rapid on-site cytopathologic examination for diagnosis of peripheral lung lesions. Lung 2009;187:55-59.
23.
Seijo LM, de Torres JP, Lozano MD, Bastarrika G, Alcaide AB, Lacunza MM, et al: Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a bronchus sign on CT imaging. Chest 2010;138:1316.
24.
Mahajan AK, Patel S, Hogarth DK, Wightman R: Electromagnetic navigational bronchoscopy: an effective and safe approach to diagnose peripheral lung lesions unreachable by conventional bronchoscopy in high-risk patients. J Bronchology Interv Pulmonol 2011;18:133.
25.
Pearlstein DP, Quinn CC, Burtis CC, Ahn KW, Katch AJ: Electromagnetic navigation bronchoscopy performed by thoracic surgeons: one center's early success. Ann Thorac Surg 2012;93:944-949.
26.
Lamprecht B, Porsch P, Wegleitner B, Strasser G, Kaiser B, Studnicka M: Electromagnetic navigation bronchoscopy (ENB): increasing diagnostic yield. Respir Med 2012;106:710-715.
27.
Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC: Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (ed 2). Chest 2007;132(3 suppl):94S-107S.
28.
Yildirim E, Kirbas I, Harman A, Ozyer U, Tore HG, Aytekin C, et al: CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications. Eur J Radiol 2009;70:57-60.
29.
Charig MJ, Phillips AJ: CT-guided cutting needle biopsy of lung lesions - safety and efficacy of an out-patient service. Clin Radiol 2000;55:964-969.
30.
Yeow KM, See LC, Lui KW, et al: Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001;12:1305-1312.
31.
Lucidarme O, Howarth N, Finet JF, et al: Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. Radiol 1998;207:759-765.
32.
Laurent F, Latrabe V, Vergier B, et al: Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovasc Interv Radiol 2000;23:266-272.
33.
Geraghty PR, Kee ST, McFarlane G, et al: CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 2003;229:475-481.
34.
Cox JE, Chiles C, McManus CM, et al: Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999;212:165-168.
35.
Ko JP, Shepard J-AO, Drucker EA, et al: Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 2001;218:491-496.
36.
Steinfort DP, Khor YH, Manser RL, Irving LB: Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011;37:902-910.
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2014
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