Article Highlights

• Electromagnetic navigational bronchoscopy (ENB) has become a commonly employed means of sampling peripheral lung lesions.

• There are several commercially available electromagnetic navigation (EMN) platforms in the United States, each with its own unique features; however, prospective comparisons of these different systems are lacking.

• The overall diagnostic yield of ENB as reported in the scientific literature ranges widely, with the largest and most recent prospective study reporting a yield of 73% [14].

• The diagnostic yield of ENB hinges heavily on the biopsy techniques employed: although transbronchial needle aspiration appears to be the most reliable method, many bronchoscopists employ more than one sampling modality in an effort to maximize diagnostic yield.

• Features intrinsic to the target lesion that may influence the efficacy of EMN-guided biopsy include size, location, and – perhaps most significantly – whether an airway leads directly into the lesion (presence of a bronchus sign).

• Risks associated with ENB pertain more directly to the biopsy methods employed or to bronchoscopy in general: most common among potential complications are pneumothorax, bleeding, and respiratory failure.

• A major limitation of EMN is its inability to compensate for changes in lung geometry and nodule-positioning that occur after acquisition of the CT scan used to plan the navigation: this is termed CT-to-body divergence.

• The incorporation of more advanced imaging modalities (for example, cone-beam CT and fluoroscopy with three-dimensional reconstruction) may allow for better visual assessment and fine-tuning of navigation, while technologies such as fluoroscopic navigation may facilitate some degree of compensation for CT-to-body divergence through intraprocedural local registration.

• The future of ENB lies in its ability to overcome its limitations (such as CT-to-body divergence), keep pace with competing technologies (such as standalone fluoroscopic navigation and other advanced bronchoscopic techniques that enable navigation and biopsy under real-time guidance), and perhaps demonstrate its utility in the arena of lung cancer therapeutics.

Declaration of Interest

T. R. Gildea has been part of several scientific advisory boards (e.g., Medtronic, Auris, Intuitive Surgical, Siemens, Ethicon/J&J, Boston Scientific) and their employer has grant support for educational activities (e.g., Veran, Olympus, etc.) that has some interaction with content. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.