The Diagnostic Yield of Navigational Bronchoscopy Performed with Propofol Deep Sedation

Objective. To describe the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) utilizing propofol for procedural deep sedation. Methods. We conducted a structured retrospective analysis of the medical records of patients who underwent ENB with propofol for the evaluation of pulmonary nodules and masses. We analyzed the relationships between lesion size and location, variance (CT-to-body divergence), and positron emission tomography findings on diagnostic yield. Diagnoses were established by histopathological evaluation and clinical-radiographic followup. Results. 41 patients underwent ENB during the study period. The overall diagnostic yield was 89% (42 of 47 target lesions). Among the 42 positive specimens, the diagnoses were squamous cell carcinoma , adenocarcinoma , small cell carcinoma , adenocarcinoma in situ , coccidioidomycosis , and inflammatory processes . Average lesion size was ？cm and variance ？mm. The diagnostic yield was greater when the lesion size was >4？cm (100%) and when variance was ≤4？mm (91% versus 87%, ). Conclusion. The diagnostic yield of ENB utilizing propofol for procedural deep sedation at our center was excellent. ENB with deep sedation may result in superior diagnostic yield compared with ENB performed with moderate sedation. 1. Introduction The diagnostic yield of flexible fiberoptic bronchoscopy is limited because of the inability to guide the biopsy needle directly to many pulmonary lesions. For lesions <2？cm in diameter, the diagnostic yield is 14% for lesions in the outer third of the chest and up to 31% in the proximal two-thirds [1]. Electromagnetic navigational bronchoscopy (ENB) is an emerging technology that improves the diagnostic yield of bronchoscopy for the assessment of peripheral pulmonary nodules. The diagnostic yield of ENB ranges from 59 to 74%, independent of lesion size and lobar distribution [2, 3]. It is designed to guide bronchoscopic biopsy tools to predetermined locations within the periphery of the bronchial tree. However, despite accurate navigation to within 10？mm of the target center in most cases, the ENB diagnostic failure rate remains clinically significant [4–6]. Respiratory variations causing larger than anticipated navigation errors [4] and dislodgement of biopsy instruments [6] may adversely affect diagnostic yield. Most reports of ENB performance have assessed outcomes among patients receiving procedural moderate sedation or general anesthesia. Our center is one of few in the United States to perform ENB with propofol deep sedation. The goals of our investigation were to