Electromagnetic Navigation Bronchoscopy Versus Radial Endobronchial Ultrasound for Diagnosing Lung Cancer: A Propensity Score-Matched Analysis

Abstract

Introduction: Electromagnetic navigation bronchoscopy (ENB) and radial endobronchial ultrasound (R-EBUS) are advanced imaging-guided bronchoscopy techniques for diagnosing pulmonary lesions. This study aimed to determine the comparative diagnostic yield of sole ENB and R-EBUS under moderate sedation. Methods: We investigated 288 patients who underwent sole ENB (n = 157) or sole R-EBUS (n = 131) under moderate sedation for pulmonary lesion biopsy between January 2017 and April 2022. After a 1:1 propensity score-matching to control for pre-procedural factors, the diagnostic yield, sensitivity for malignancy, and procedure-related complications between both techniques were compared. Results: The matching resulted in 105 pairs/procedure for analyses with balanced clinical and radiological characteristics. The overall diagnostic yield was significantly higher for ENB than for R-EBUS (83.8% vs. 70.5%, p = 0.021). ENB demonstrated a significantly higher diagnostic yield than R-EBUS among those with lesions > 20 mm in size (85.2% vs. 72.3%, p = 0.034), radiologically solid lesions (86.7% vs. 72.7%, p = 0.015), and lesions with a class 2 bronchus sign (91.2% vs. 72.3%, p = 0.002), respectively. The sensitivity for malignancy was also higher for ENB than for R-EBUS (81.3% vs. 55.1%, p < 0.001). After adjusting for clinical/radiological factors in the unmatched cohort, using ENB over R-EBUS was significantly associated with a higher diagnostic yield (odd ratio = 3.45, 95% confidence interval = 1.75–6.82). Complication rates for pneumothorax did not significantly differ between ENB and R-EBUS. Conclusion: ENB demonstrated a higher diagnostic yield than R-EBUS under moderate sedation for diagnosing pulmonary lesions, with similar and generally low complication rates. Our data indicate the superiority of ENB over R-EBUS in a least-invasive setting.