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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Pulmonary Medicine 1/2017

Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, multicenter NAVIGATE study

Zeitschrift:
BMC Pulmonary Medicine > Ausgabe 1/2017
Autoren:
Sandeep J. Khandhar, Mark R. Bowling, Javier Flandes, Thomas R. Gildea, Kristin L. Hood, William S. Krimsky, Douglas J. Minnich, Septimiu D. Murgu, Michael Pritchett, Eric M. Toloza, Momen M. Wahidi, Jennifer J. Wolvers, Erik E. Folch, for the NAVIGATE Study Investigators
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12890-017-0403-9) contains supplementary material, which is available to authorized users.
Prior Presentation: Presented at the IASLC 17th World Conference on Lung Cancer, December 5, 2016: Folch E, Flandes J, Khandhar S. MA05.02 Electromagnetic Navigation Bronchoscopy: A Prospective, Global, Multicenter Analysis of 1000 Subjects with Lung Lesions. Journal of Thoracic Oncology. 2017;12:S365.

Abstract

Background

Electromagnetic navigation bronchoscopy (ENB) is an image-guided, minimally invasive approach that uses a flexible catheter to access pulmonary lesions.

Methods

NAVIGATE is a prospective, multicenter study of the superDimension™ navigation system. A prespecified 1-month interim analysis of the first 1,000 primary cohort subjects enrolled at 29 sites in the United States and Europe is described. Enrollment and 24-month follow-up are ongoing.

Results

ENB index procedures were conducted for lung lesion biopsy (n = 964), fiducial marker placement (n = 210), pleural dye marking (n = 17), and/or lymph node biopsy (n = 334; primarily endobronchial ultrasound-guided). Lesions were in the peripheral/middle lung thirds in 92.7%, 49.7% were <20 mm, and 48.4% had a bronchus sign. Radial EBUS was used in 54.3% (543/1,000 subjects) and general anesthesia in 79.7% (797/1,000). Among the 964 subjects (1,129 lesions) undergoing lung lesion biopsy, navigation was completed and tissue was obtained in 94.4% (910/964). Based on final pathology results, ENB-aided samples were read as malignant in 417/910 (45.8%) subjects and non-malignant in 372/910 (40.9%) subjects. An additional 121/910 (13.3%) were read as inconclusive. One-month follow-up in this interim analysis is not sufficient to calculate the true negative rate or diagnostic yield. Tissue adequacy for genetic testing was 80.0% (56 of 70 lesions sent for testing). The ENB-related pneumothorax rate was 4.9% (49/1,000) overall and 3.2% (32/1,000) CTCAE Grade ≥2 (primary endpoint). The ENB-related Grade ≥2 bronchopulmonary hemorrhage and Grade ≥4 respiratory failure rates were 1.0 and 0.6%, respectively.

Conclusions

One-month results of the first 1,000 subjects enrolled demonstrate low adverse event rates in a generalizable population across diverse practice settings. Continued enrollment and follow-up are required to calculate the true negative rate and delineate the patient, lesion, and procedural factors contributing to diagnostic yield.

Trial registration

ClinicalTrials.gov NCT02410837. Registered 31 March 2015.
Zusatzmaterial
Additional file 1: Study assessments. (DOCX 52 kb)
12890_2017_403_MOESM1_ESM.docx
Additional file 2: Study definitions. (DOCX 56 kb)
12890_2017_403_MOESM2_ESM.docx
Additional file 3: Study sites enrolling subjects in the 1,000-Patient interim analysis. (DOCX 53 kb)
12890_2017_403_MOESM3_ESM.docx
Additional file 4: Ethics committee approvals. (DOCX 54 kb)
12890_2017_403_MOESM4_ESM.docx
Literatur
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