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

• Published in: BMC pulmonary medicine Vol. 17; no. 1; pp. 59 - 9
• Main Authors: Khandhar, Sandeep J., Bowling, Mark R., Flandes, Javier, Gildea, Thomas R., Hood, Kristin L., Krimsky, William S., Minnich, Douglas J., Murgu, Septimiu D., Pritchett, Michael, Toloza, Eric M., Wahidi, Momen M., Wolvers, Jennifer J., Folch, Erik E.
• Format: Journal Article
• Language: English
• Published: England BioMed Central 11.04.2017; BMC
• Subjects: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Anesthesia; Benign; Biopsy; Bronchoscopy; Bronchoscopy - methods; Chest; Chronic obstructive pulmonary disease; Classification; Clinical medicine; Computed tomography; Data processing; Diagnosis, Differential; Dyes; Electromagnetic Phenomena; Enrollments; Europe; Female; Genotyping; Hemorrhage; Humans; Image-Guided Biopsy; Image-Guided Biopsy - methods; Information processing; Intravenous administration; Lung - pathology; Lung Cancer; Lung diseases; Lung Neoplasms; Lung Neoplasms - diagnosis; Lymph nodes; Lymph Nodes - pathology; Male; Malignancy; Medical screening; Medicare; Middle Aged; Neoplasm Staging; Nodules; Nursing; Patients; Pneumothorax - epidemiology; Pneumothorax - etiology; Pregnancy; Prospective Studies; Pulmonary lesions; Pulmonology; Respiratory failure; Solitary Pulmonary Nodule; Statistical analysis; Studies; Success; Thorax; Tomography, X-Ray Computed; Ultrasound; United States; Young Adult; United States > US; Lung Cancer; Solitary Pulmonary Nodule; Neoplasm Staging; Lung Neoplasms; Image-Guided Biopsy
• DOI: 10.1186/s12890-017-0403-9
• ISSN: 1471-2466

Electromagnetic navigation bronchoscopy (ENB) is an image-guided, minimally invasive approach that uses a flexible catheter to access pulmonary lesions. 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. 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. 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. ClinicalTrials.gov NCT02410837 . Registered 31 March 2015.