Intraprocedural CT guided Navigation with Ventilatory Strategy for Atelectasis (ICNVA): a modified electromagnetic navigation bronchoscopy

Abstract Background: CT-body divergence limits the accuracy of electromagnetic navigation bronchoscopy (ENB) in peripheral lung lesions diagnosis. We developed intraprocedural CT guided Navigation with Ventilatory Strategy for Atelectasis (ICNVA) ENB for patients with peripheral lung lesions. Methods: Retrospective observational study in which ten consecutive patients with pulmonary lesions (without bronchial direct connection) underwent ICNVA-ENB was conducted. We collected three sets of CT data: preENB CT, post-anesthesia intubation CT, and postENB CT. To evaluated the accuracy of ICNVA-ENB, we measured the distance between the ENB probe and the actual lesion location, but also recorded the results of rapid on-site evaluation (ROSE), and postoperative pathology. To evaluate the impact of CT-body divergence induced by atelectasis, we calculated the mutual position distance of target lesions in preENB CT, post-anesthesia intubation CT and postENB CT. Furthermore, ENB operation time, operative complications were recorded. Results: Our analysis revealed that the distance between the navigation probe with the actual location of lesion center is 4–10 (5.90±1.73) mm. The ROSE results were consistent with the postoperative pathological diagnosis in 9 out of 10 patients (90%). The ICNVA-ENB atelectasis CT-body divergence was smaller than traditional ENB ((12.10±3.67)mm vs (6.60±2.59)mm, p＜0.01). The ENB operation time was 20-53(29.30±10.14) minutes and one patient developed slight intrapulmonary hemorrhage. Conclusions: ICNVA-ENB can reduce the CT-body divergence and appears to be safe and accurate for patients with peripheral lung lesions.