The current nonsurgical techniques available to diagnose small peripheral lung lesions (SPLL) are limited either by low accuracy or by possible complications.

The diagnostic yield of bronchoscopy for SPLL may be lower than 30%. On the other hand, transthoracic needle aspiration may reach a diagnostic yield of over 85% in SPLL but it is associated with increased pneumothorax rates that range from 23 to 44%.

Electromagnetic navigation during bronchoscopy (EGB) is a novel technique that can guide the biopsy of endobronchial invisible peripheral lesions and aims to improve the diagnostic yield of bronchoscopy. Charles-Hugo Marquette (Centre Hospitalier Régional Universitaire de Lille, Lille, France) and his colleagues prospectively examined the diagnostic yield of EGB for SPLL and the incidence of complications related to this technique. They included 40 patients with SPLL not eligible for straightforward curative surgery due to co-morbidities, in which conventional bronchoscopy was not diagnostic. The examined lesions had a mean size of 23.5 (min-max 8-49) mm and their mean depth from visceral costal pleura was 15mm.

As a result of EBG, diagnoses were obtained in 25 out of 40 cases (62.5%). Three pneumothoraces occurred in this series (one of them required drainage). The authors conclude that EGB without additional fluoroscopic guidance is a safe and efficient technique for the diagnosis of SPLL. In contrast to fluoroscopy, it is not associated with radiation exposure. EGB has the potential of substantial contribution to the early diagnosis of lung cancer, particularly in patients considered medically inoperable.

Title of the original article:
Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions

The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 8,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia). erj.ersjournals