{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:44:20Z","timestamp":1789062260535,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:00:00Z","timestamp":1660780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Bronchoscopic biopsy results for indeterminate pulmonary nodules remain suboptimal. Electromagnetic navigation bronchoscopy (ENB) coupled with cone beam computed tomography (CBCT) for confirmation has the potential to improve diagnostic yield. We present our experience using this multimodal approach to biopsy 17 indeterminate nodules in 14 consecutive patients from April to August 2021. Demographic information, nodule characteristics, and biopsy results were recorded. Procedures were performed in a hybrid operating room equipped with a Siemens Artis Q bi-plane CBCT (Siemens, Munich, Germany). After ENB using the superDimension version 7.1 (Medtronic, Plymouth, MN, USA) to target the lesion, radial endobronchial ultrasound was used as secondary confirmation. Next, transbronchial needle aspiration was performed prior to CBCT to evaluate placement of the biopsy tool in the lesion. The average nodule size was 21.7+\/\u221215 mm with 59% (10\/17) &lt; 2 cm in all dimensions and 35% (6\/17) showing a radiographic bronchus sign. The diagnostic yield of CBCT-guided ENB was 76% (13\/17). No immediate periprocedural or postprocedural complications were identified. Our experience with CBCT-guided ENB further supports the comparable efficacy and safety of this procedure compared to other mature biopsy modalities. Studies designed to optimize the lung nodule biopsy process and to determine the contributions from different procedural aspects are warranted.<\/jats:p>","DOI":"10.3390\/tomography8040172","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T02:48:23Z","timestamp":1660877303000},"page":"2049-2058","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Efficacy and Safety of Cone-Beam CT Augmented Electromagnetic Navigation Guided Bronchoscopic Biopsies of Indeterminate Pulmonary Nodules"],"prefix":"10.3390","volume":"8","author":[{"given":"Shreya","family":"Podder","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Chaudry","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise M.","family":"Jondall","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8018-496X","authenticated-orcid":false,"given":"Jonathan S.","family":"Kurman","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan S.","family":"Benn","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1056\/NEJMoa1102873","article-title":"Reduced lung-cancer mortality with low-dose computed tomographic screening","volume":"365","author":"Aberle","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1911793","article-title":"Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial","volume":"382","author":"Scholten","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1001\/jama.2021.0377","article-title":"Screening for Lung Cancer with Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force","volume":"325","author":"Jonas","year":"2021","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1164\/rccm.201505-0990OC","article-title":"Recent Trends in the Identification of Incidental Pulmonary Nodules","volume":"192","author":"Gould","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1148\/radiol.2262010556","article-title":"Small Pulmonary Nodules: Detection at Chest CT and Outcome","volume":"226","author":"Benjamin","year":"2003","journal-title":"Radiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1001\/archinte.1997.00440290031002","article-title":"The probability of malignancy in solitary pulmonary nodules: Application to small radiologically indeterminate nodules","volume":"157","author":"Swensen","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1056\/NEJMoa1214726","article-title":"Probability of Cancer in Pulmonary Nodules Detected on First Screening CT","volume":"369","author":"McWilliams","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1513\/AnnalsATS.201305-107OC","article-title":"Accuracy of Clinicians and Models for Estimating the Probability That a Pulmonary Nodule Is Malignant","volume":"10","author":"Balekian","year":"2013","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4103\/atm.ATM_110_19","article-title":"Lung nodules: A comprehensive review on current approach and management","volume":"14","author":"Gaga","year":"2019","journal-title":"Ann. Thorac. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e142S","DOI":"10.1378\/chest.12-2353","article-title":"Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines","volume":"143","author":"Rivera","year":"2013","journal-title":"Chest"},{"key":"ref_11","first-page":"S304","article-title":"Transthoracic needle biopsy of the lung","volume":"7","author":"DiBardino","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"596925","DOI":"10.3389\/fsurg.2020.596925","article-title":"Current Novel Advances in Bronchoscopy","volume":"7","author":"Jiang","year":"2020","journal-title":"Front. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000355710","article-title":"Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: A systematic review and meta-analysis","volume":"87","author":"Gex","year":"2014","journal-title":"Respiration"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1378\/chest.11-1764","article-title":"Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule","volume":"142","author":"Memoli","year":"2012","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Khandhar, S.J., Bowling, M.R., Flandes, J., Gildea, T.R., Hood, K.L., Krimsky, W.S., Minnich, D.J., Murgu, S.D., Pritchett, M., and Toloza, E.M. (2017). Electromagnetic navigation bronchoscopy to access lung lesions in 1000 subjects: First results of the prospective, multicenter NAVIGATE study. BMC Pulm. Med., 17.","DOI":"10.1186\/s12890-017-0403-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1378\/chest.14-1425","article-title":"The effect of respiratory motion on pulmonary nodule location during electromagnetic navigation bronchoscopy","volume":"147","author":"Chen","year":"2015","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4593","DOI":"10.21037\/jtd-2020-60","article-title":"Virtual or reality: Divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy","volume":"8","author":"Pritchett","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/resp.13609","article-title":"Improved diagnostic yield for lung nodules with digital tomosynthesis-corrected navigational bronchoscopy: Initial experience with a novel adjunct","volume":"25","author":"Aboudara","year":"2020","journal-title":"Respirology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1159\/000518009","article-title":"Sight Unseen: Diagnostic Yield and Safety Outcomes of a Novel Multimodality Navigation Bronchoscopy Platform with Real-Time Target Acquisition","volume":"101","author":"Avasarala","year":"2022","journal-title":"Respiration"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/LBR.0000000000000687","article-title":"Electromagnetic Navigation Bronchoscopy with Tomosynthesis-based Visualization and Positional Correction: Three-dimensional Accuracy as Confirmed by Cone-Beam Computed Tomography","volume":"28","author":"Pritchett","year":"2021","journal-title":"J. Bronc. Interv. Pulmonol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1513\/AnnalsATS.201607-522BC","article-title":"Same-Day Computed Tomographic Chest Imaging for Pulmonary Nodule Targeting with Electromagnetic Navigation Bronchoscopy May Decrease Unnecessary Procedures","volume":"13","author":"Semaan","year":"2016","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.chest.2017.06.004","article-title":"Comparing Pulmonary Nodule Location During Electromagnetic Bronchoscopy with Predicted Location on the Basis of Two Virtual Airway Maps at Different Phases of Respiration","volume":"153","author":"Furukawa","year":"2018","journal-title":"Chest"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/028418519503600464","article-title":"CT-assessment of dependent lung densities in man during general anaesthesia","volume":"36","author":"Lundquist","year":"1995","journal-title":"Acta Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1164\/rccm.201507-1332OC","article-title":"Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry","volume":"193","author":"Ost","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jtho.2018.11.013","article-title":"Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions: One-Year Results of the Prospective, Multicenter NAVIGATE Study","volume":"14","author":"Folch","year":"2019","journal-title":"J. Thorac. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.chest.2020.05.534","article-title":"Sensitivity and Safety of Electromagnetic Navigation Bronchoscopy for Lung Cancer Diagnosis: Systematic Review and Meta-analysis","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1097\/LBR.0000000000000645","article-title":"The Diagnostic Accuracy and Sensitivity for Malignancy of Radial-Endobronchial Ultrasound and Electromagnetic Navigation Bronchoscopy for Sampling of Peripheral Pulmonary Lesions: Systematic Review and Meta-analysis","volume":"27","author":"McGuire","year":"2020","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"231","DOI":"10.7150\/jca.8834","article-title":"Cone Beam Computer tomography (CBCT) in Interventional Chest Medicine\u2014High Feasibility for Endobronchial Realtime Navigation","volume":"5","author":"Zarogoulidis","year":"2014","journal-title":"J. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s00408-021-00421-1","article-title":"Robotic-Assisted Navigation Bronchoscopy as a Paradigm Shift in Peripheral Lung Access","volume":"199","author":"Benn","year":"2021","journal-title":"Lung"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000500228","article-title":"Transbronchial Biopsy Using an Ultrathin Bronchoscope Guided by Cone-Beam Computed Tomography and Virtual Bronchoscopic Navigation in the Diagnosis of Pulmonary Nodules","volume":"98","author":"Ali","year":"2019","journal-title":"Respiration"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6950","DOI":"10.21037\/jtd.2018.11.21","article-title":"Cone beam computed tomography-guided thin\/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: A prospective pilot study","volume":"10","author":"Casal","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1183\/09031936.00075310","article-title":"Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: Systematic review and meta-analysis","volume":"37","author":"Steinfort","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1378\/chest.126.3.959","article-title":"Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically","volume":"126","author":"Kurimoto","year":"2004","journal-title":"Chest"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1513\/AnnalsATS.201711-856OC","article-title":"Computed Tomography Bronchus Sign and the Diagnostic Yield of Guided Bronchoscopy for Peripheral Pulmonary Lesions. A Systematic Review and Meta-Analysis","volume":"15","author":"Ali","year":"2018","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/LBR.0000000000000120","article-title":"The effect of general anesthesia versus intravenous sedation on diagnostic yield and success in electromagnetic navigation bronchoscopy","volume":"22","author":"Bowling","year":"2015","journal-title":"J. Bronc. Interv. Pulmonol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/LBR.0000000000000499","article-title":"Robotic Bronchoscopy for Diagnosis of Suspected Lung Cancer: A Feasibility Study","volume":"25","author":"Machuzak","year":"2018","journal-title":"J. Bronc. Interv. Pulmonol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Chaddha, U., Kovacs, S.P., Manley, C., Hogarth, D.K., Cumbo-Nacheli, G., Bhavani, S.V., Kumar, R., Shende, M., Egan, J.P., and Murgu, S. (2019). Robot-assisted bronchoscopy for pulmonary lesion diagnosis: Results from the initial multicenter experience. BMC Pulm. Med., 19.","DOI":"10.1186\/s12890-019-1010-8"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1089\/soro.2018.0131","article-title":"Fiber Optic Shape Sensing for Soft Robotics","volume":"6","author":"Galloway","year":"2019","journal-title":"Soft Robot."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.chest.2021.07.2169","article-title":"Shape-Sensing Robotic-Assisted Bronchoscopy in the Diagnosis of Pulmonary Parenchymal Lesions","volume":"161","author":"Connolly","year":"2022","journal-title":"Chest"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.21037\/tlcr-20-1231","article-title":"Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance\u2014A novel technique and initial experience with 30 cases","volume":"10","author":"Chan","year":"2021","journal-title":"Transl. Lung Cancer Res."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/8\/4\/172\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:11:44Z","timestamp":1760141504000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/8\/4\/172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,18]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["tomography8040172"],"URL":"https:\/\/doi.org\/10.3390\/tomography8040172","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,18]]}}}