Chinese expert consensus on technical specifications of electromagnetic navigation bronchoscopy in diagnosing peripheral pulmonary lesions.

Abstract

Electromagnetic navigation bronchoscopy (ENB) is a technology that allows real-time navigation to the target peripheral pulmonary lesions (PPLs) during bronchoscopy. The system uses virtual bronchoscopy and threedimensional (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. ENB has been used in clinical practice since 2005 but increasingly more in recent years (1,2). Previous studies demonstrated that ENB was effective and safe for the diagnosis of PPLs. 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). ENB-guided transbronchial lung biopsy (TBLB) is an important part of such guided bronchoscopy (5). The superDimensionTM navigation system (Medtronic; Dublin, Ireland) was a commonly used ENB system in clinics across the United States. It requires a large working channel of the bronchoscope due to the comparably large locatable guide and extended working channel (6). The more recently developed SPiN Navigation System (Veran Medical Technologies; St. Louis, MO, USA) combines ENB and electromagnetic navigation-guided transthoracic needle aspiration during the procedure. 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. 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). It has been approved for use in clinical practice since 2016 in China. However, the procedures of this novel technique in diagnosing PPLs are not standardized. This consensus statement has been Expert Consensus