134P Predictors of success and complications in electromagnetic navigation bronchoscopy of peripheral lung lesions: A retrospective cohort study

We evaluated diagnostic performance and complication rate of electromagnetic navigation bronchoscopy (ENB) as well as predictors of outcomes in a single-center cohort. All patients having undergone ENB using a superDimension system (Medtronic, Minneapolis, Minnesota) at Kepler University Hospital Linz, Austria, between 2014 and 2022 were retrospectively enregistered. ENB was performed under general anaesthesia, standardized post-interventional follow-up included a chest X-ray after three hours. Severe complications were defined as pneumothorax or bronchial bleeding with need for intervention, procedure-related death, or ICU admission. Success was defined as reaching the lesion to <1cm of the predefined target and no need for further diagnostic intervention. A total of 238 separate ENB procedures in 231 patients (mean age 66 years, 58% male) were evaluated. The procedure was successful in 124 (52%), the target lesion was reached but information obtained was insufficient in 98 (41%), and the target lesion could not be reached in 16 (7%) patients. Success was significantly associated with smoking history <30 pack-years (OR 2.75, p=0.0013), lesion location in the middle (OR 3.68, p=0.002) or upper (OR 2.79, p=0.01) versus the lower lung third in the frontal plane, and with a positive bronchus sign (OR 2.95, p<0.001). Pneumothorax occurred in 32 (13.5%) patients, bronchial bleeding in 5 (2.1%), overall complication rate was 14.7%. All 11 (4.6%) severe complications were pneumothoraces requiring intervention. Predictors of overall complication rate were a location in the anterior (OR 4.32, p=0.014) or medial (OR 6.99, p<0.001) versus the posterior lung third in the horizontal plane, distance lesion to pleura <9mm (OR 6.64, p<0.001), and low PET activity (OR 2.9, p=0.045). Diagnostic performance of ENB was higher in patients with less smoking history, upper- or middle frontal lung field localization and a positive bronchus sign. Complications – mainly pneumothoraces – rather occurred in lesions with low PET activity, vicinity to the pleura, and in the anterior or medial horizontal lung thirds.