{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:33:54Z","timestamp":1792787634280,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Veran Inc."},{"name":"Veran Inc."}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Strict adherence to procedural protocols and diagnostic definitions is critical to understand the efficacy of new technologies. Electromagnetic navigational bronchoscopy (ENB) for lung nodule biopsy has been used for decades without a solid understanding of its efficacy, but offers the opportunity for simultaneous tissue acquisition via electromagnetic navigational transthoracic biopsy (EMN-TTNA) and staging via endobronchial ultrasound (EBUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic yield of EBUS, ENB, and EMN-TTNA during a single procedure using a strict a priori definition of diagnostic yield with central pathology adjudication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, single-arm trial was conducted at eight centers enrolling participants with pulmonary nodules (&amp;lt;3\u2009cm; without computed tomography [CT]\u2013 and\/or positron emission tomography\u2013positive mediastinal lymph nodes) who underwent a staged procedure with same-day CT, EBUS, ENB, and EMN-TTNA. The procedure was staged such that, when a diagnosis had been achieved via rapid on-site pathologic evaluation, the procedure was ended and subsequent biopsy modalities were not attempted. A study finding was diagnostic if an independent pathology core laboratory confirmed malignancy or a definitive benign finding. The primary endpoint was the diagnostic yield of the combination of CT, EBUS, ENB, and EMN-TTNA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>A total of 160 participants at 8 centers with a mean nodule size of 18\u2009\u00b1\u20096\u2009mm were enrolled. The diagnostic yield of the combined procedure was 59% (94 of 160; 95% confidence interval [CI], 51\u201366%). Nodule regression was found on same-day CT in 2.5% of cases (4 of 160; 95% CI, 0.69\u20136.3%), and EBUS confirmed malignancy in 7.1% of cases (11 of 156; 95% CI, 3.6\u201312%). The yield of ENB alone was 49% (74 of 150; 95% CI, 41\u201358%), that of EMN-TTNA alone was 27% (8 of 30; 95% CI, 12\u201346%), and that of ENB plus EMN-TTNA was 53% (79 of 150; 95% CI, 44\u201361%). Complications included a pneumothorax rate of 10% and a 2% bleeding rate. When EMN-TTNA was performed, the pneumothorax rate was 30%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The diagnostic yield for ENB is 49%, which increases to 59% with the addition of same-day CT, EBUS, and EMN-TTNA, lower than in prior reports in the literature. The high complication rate and low diagnostic yield of EMN-TTNA does not support its routine use.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT 03338049).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202301-0099oc","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T13:51:56Z","timestamp":1692107516000},"page":"837-845","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":35,"title":["A Multicenter, Single-Arm, Prospective Trial Assessing the Diagnostic Yield of Electromagnetic Bronchoscopic and Transthoracic Navigation for Peripheral Pulmonary Nodules"],"prefix":"10.1093","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7388-4191","authenticated-orcid":false,"given":"Jeffrey","family":"Thiboutot","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Pastis","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Ohio State University, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Akulian","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard A.","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momen M.","family":"Wahidi","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng Ting","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Los","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Flenaugh","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Semaan","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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