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The American College of Chest Physicians ( ACCP) guidelines recommend ENB in patients with PPLs that are difficult to reach with conventional bronchoscopy ( 12).
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PPLs are defined as lesions beyond the segmental bronchi that are not visible using bronchoscopy (no endobronchial lesion, extrinsic compression, submucosal tumor, and no narrowing, inflammation, or bleeding of the bronchus) ( 11). Patients meeting the above criteria may undergo ENB-guided TBLB, particularly when they have PPLs located in the peripheral third of the lung or the upper lobes, showing a positive bronchus sign, a diameter ≤20 mm ( 10). The consensus was reached through discussion and limited to expert suggestions.Ĭandidates for ENB diagnosis are patients with (I) PPLs either suspicious for malignancy or deemed benign requiring tissue samples or microbiological evidence for their definitive diagnosis and treatment, and (II) a PPL diameter of more than 8 mm ( 9). All authors have abundant clinical experience in TBLB and ENB technology.ĭue to the lack of evidence on the clinical use and diagnostic outcomes of the novel ENB system in the literature, this consensus represents an expert group agreement on general suggestions without formal individual rating of the level of evidence and strength of recommendations.
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This consensus statement has been organized and written in a collaborative effort by the Interventional & Minimally Invasive Respiratory Committee of the China Medical Education Association and the Expert Assistance Group of the Domestic Electromagnetic Navigation Bronchoscopy Technology and aims to develop practice guidelines for the use of this novel ENB system in the diagnosis of PPLs, standardize the procedures, and ensure optimal performance of ENB. However, the procedures of this novel technique in diagnosing PPLs are not standardized. It has been approved for use in clinical practice since 2016 in China. Finally, the latest ENB system (LungCare navigation system LungCare Medical Technologies Ltd., Inc, Suzhou, China) can be used in combination with a thin or ultrathin bronchoscope because it has different types of locatable wires with a promising performance ( 7, 8). The tip of its sampling tool carries a sensor that allows the precise tracking of both the position and orientation of the tip in real-time through the electromagnetic field. Louis, MO, USA) combines ENB and electromagnetic navigation-guided transthoracic needle aspiration during the procedure. The more recently developed SPiN Navigation System ® (Veran ® Medical Technologies St. It requires a large working channel of the bronchoscope due to the comparably large locatable guide and extended working channel ( 6). The superDimension™ navigation system (Medtronic Dublin, Ireland) was a commonly used ENB system in clinics across the United States. ENB-guided transbronchial lung biopsy (TBLB) is an important part of such guided bronchoscopy ( 5). Two meta-analyses reported that the sensitivity for diagnosing a PPL and the risk of complications were 71.1% and 4.2%, and 77% and 4.4%, respectively ( 3, 4). Previous studies demonstrated that ENB was effective and safe for the diagnosis of PPLs. ENB has been used in clinical practice since 2005 but increasingly more in recent years ( 1, 2). The system uses virtual bronchoscopy and three-dimensional (3D) computed tomography (CT) images, in combination with a sensor and electromagnetic field, to enable the navigation of dedicated tools to the target area of the lung.
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Electromagnetic navigation bronchoscopy (ENB) is a technology that allows real-time navigation to the target peripheral pulmonary lesions (PPLs) during bronchoscopy.