Background
death, TBLC, cancer, Lung cancer, malignancy
CANCER, LUNG CANCER
Lung cancer is the cause of 1.80 million death in 2020 in the world and is the leading cause of cancer related death [Electromagnetic Navigation Bronchoscopy (ENB), a kind of GPS navigation system in the bronchi, aims to guide a catheter and biopsy instruments to the target. This technique improves the localization of the nodule and increases the diagnostic yield of biopsies with diagnostic yields ranging from 52 to 72,9% [In our current practice, this technique is routinely used in an endoscopic suite in combination with X-ray fluoroscopic guidance, EBUS radial mini-probe (rEBUS) and trans-bronchial lung cryobiopsies (TBLCs) in addition to trans-bronchial biopsies (TBBs). The combination of TBLC to the ENB technique increased significantly the diagnostic yield of the ENB for the diagnosis of lung nodules of less than 20 mm [Nevertheless, even if the combined use of these techniques increases the chance to diagnose lesions that are difficult to access, some of them are still not reached. As ENB procedure are based on pre-procedural HRCT performed a few days before the procedure (on awake patient holding breath at maximum inspiration), the exact position of the nodule could be slightly different between this pre-procedural HRCT and its real position during the procedure itself performed under general anesthesia (CT-to-body divergence). It could result into a mispositioning or a misorientation of biopsy instruments. Also, the lack of visible bronchus leading to the nodule (lack of bronchus sign) or the presence of tight angulations of the pathway reduce its accessibility. To solve these issues, ENB procedure can be performed in a hybrid room equipped by a cone beam computed tomography (CBCT), which is a variation of traditional computed tomography systems. The CBCT rotates around the patient, capturing data using a cone-shaped X-ray beam. These data are used to reconstruct a three-dimensional (3D) image, to obtain a real-time evaluation of the position of the ENB catheter and to visualize the lesion during X-ray fluoroscopy (enhanced fluoroscopy). Another advantage of CBCT is the use of trans-parenchymal access tools such as the “CrossCountry” catheter developed by Medtronic to reach the lesion if ENB alone does not allow a confident positioning of the catheter within the targeted lesion [To our knowledge, no study evaluated prospectively the benefit of performing ENB under CBCT guidance or under standard X-ray fluoroscopic guidance alone. Therefore, the aim of this study was to compare the diagnostic yield and diagnostic accuracy for malignancy of ENB procedures coupled to TBBs and TBLCs for the diagnosis of pulmonary nodule when performed either in a "standard" bronchoscopy suite or in a hybrid room equipped by a CBCT.