Sensitivity for Malignancy with Navigation Bronchoscopy in Small Lung Nodules

Abstract

Highlights What are the main findings? Sensitivity for malignancy with electromagnetic navigation bronchoscopy (ENB) was markedly lower in nodules ≤10 mm than in larger lesions. Lesion size and bronchus sign were independently associated with diagnostic sensitivity. What are the implications of the main findings? ENB should be considered selectively in very small nodules and interpreted alongside pretest probability and anatomy. Surveillance, surgery, or newer bronchoscopic platforms may be appropriate depending on risk, accessibility, and local resources. Abstract Electromagnetic navigation bronchoscopy (ENB) is used for minimally invasive assessment of peripheral pulmonary nodules, but data on lesions ≤10 mm are limited. When ENB is performed for suspected lung cancer, the key clinical question is whether malignancy is detected rather than whether any diagnosis is obtained. For this reason, sensitivity for malignancy was selected over diagnostic yield as the primary outcome. We retrospectively analyzed 541 consecutive ENB procedures performed at Skåne University Hospital during 2018–2019 and followed patients for at least two years to determine final diagnosis. Overall, 323 lesions (59.7%) were malignant and median lesion diameter was 13 mm. Sensitivity for malignancy was 44.0% overall but was markedly lower in lesions ≤10 mm than in larger lesions (23.3% vs. 50.0%, p < 0.001). Larger lesion size and the presence of a bronchus sign were independently associated with higher sensitivity, whereas lower lobe location was associated with reduced sensitivity. In very small nodules, the low probability of obtaining a malignant diagnosis with ENB should be considered when selecting patients and weighing ENB against surveillance, surgery, or alternative diagnostic approaches.