Electromagnetic Navigation Bronchoscopy in Combination with PET-CT and Rapid On-site Cytopathologic Examination for Diagnosis of Peripheral Lung Lesions

Background The combination of electromagnetic navigation bronchoscopy (ENB), PET-CT, and rapid on-site cytopathologic examination (ROSE) for the routine diagnostic work-up of peripheral lung lesions has not been evaluated previously. Objectives The aim of this study was to determine the accuracy and safety of ENB in combination with PET-CT and ROSE in subjects with endobronchially invisible peripheral lung lesions. Methods ENB was performed in 13 subjects with radiologically suspected lung cancer who were referred to our tertiary-care hospital between October 2005 and November 2006. ENB was performed using the superDimension/Bronchus System. FDG-PET-CT scans were part of the diagnostic workup. Bronchoscopy was done under general anesthesia and ROSE was available in this setting. The final diagnosis was based on the histopathologic results of specimens obtained either by ENB or, if ENB was not diagnostic, by surgery or CT-guided fine-needle aspiration (FNA). Results The mean diameter of peripheral lesions ranged from 1.4 to 5.3 cm (average = 3.0 ± 1.2 cm). In 76.9% of the patients, ENB resulted in obtaining a correct diagnosis, as defined by the definite histopathologic result. Sensitivity and specificity of ROSE was 84.6 and 100%, respectively. In malignant lesions the SUV ranged from 2.0 to 17.0 and was independent of lesion size. The positive predictive value of a positive PET-CT scan for a diagnosis of malignancy was 90%. No ENB-related adverse events were seen during and up to 24 h after bronchoscopy. Conclusion ENB in combination with PET-CT and ROSE is safe and effective in the diagnostic workup of peripheral lung lesions.