BlueCross BlueShield of Tennessee Medical Policy Manual

Electromagnetic Navigation Bronchoscopy

DESCRIPTION

Electromagnetic navigation bronchoscopy (ENB), also known as virtual bronchoscopic navigation (VBN), is an enhancement to standard bronchoscopy that provides a three-dimensional roadmap of the lungs and real-time navigation to aid the physician in guiding endoscopic tools within the pulmonary tract. Information from a steerable bronchoscope probe allows transbronchial forceps to biopsy suspicious lesion(s). The purpose of ENB (e.g., inReach™ ig4™ EndoBronchial system, LungPoint™, SPiN Thoracic Navigation System™), is to allow navigation to the distal one third regions of the lungs. Imaging (PET or CT) is useful before selecting a biopsy site so that one that will confer the highest stage of lung cancer will be chosen.

ENB has also been proposed as a method for fiducial marker placement prior to radiotherapy. Fiducial markers are gold seeds or stainless steel screws that are implanted around a soft tissue tumor to act as a radiologic landmark, to define the target lesion's position with millimeter precision. However, data on the safety and effectiveness of using ENB for fiducial marker placement is lacking.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

American College of Chest Physicians. (May, 2013). Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Retrieved December 8, 2015 from http://www.chestnet.org/Guidelines-and-Resources/CHEST-Guideline-Topic-Areas/Thoracic-Oncology.

BlueCross BlueShield Association. Evidence Positioning System. (6:2018). Electromagnetic navigation bronchoscopy (7.01.122). Retrieved December 10, 2018 from https://www.evidencepositioningsystem.com/.  (22 articles and/or guidelines reviewed)

Diken, Ӧ. E., Karnak, D., Çiledağ, A., Ceyhan, K., Atasoy, Ç., Akyar, S., & Kayacan, O. (2015). Electromagnetic navigation-guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy. The Clinical Respiratory Journal, 9 (2), 214-220. Abstract retrieved December 8, 2015 from PubMed database.

Gex, G., Pralong, J., Combescure, C., Seijo, L., Rochat, T., &  Soccal, P. (2014) Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and metaanalysis. Respiration, 87 (2), 165-76. Abstract retrieved January 26, 2018 from PubMed database.

Hagmeyer, L., Priegnitz, C., Kocher, M., Schilcher, B., Budach, W., Treml, M. et al. (2016). Clinical Respiratory Journal, 10 (3), 291-297. Abstract retrieved January 26, 2018 from PubMed database.

Khandhar, S., Bowling, M., Flandes, J., Gildea, T., Hood, K., Krimsky, W., et al. (2017) Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, multicenter NAVIGATE study. BMC Pulmonary Medicine, 17 (59) e-published ahead of print. (Level 2 evidence)

Loo, F., Halligan, A., Port, J., & Hoda, R. (2014). The emerging technique of electromagnetic navigation bronchoscopy-guided fine-needle aspiration of peripheral lung lesions. Cancer Cytopathology, 122, 191-199.

National Comprehensive Cancer Network (2018, November). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Non-small cell lung cancer v2.2019. Retrieved December 10, 2018 from the National Comprehensive Cancer Network.

U.S. Food and Drug Administration. (2009, May). Center for Devices and Radiological Health. 510(k) Premarket notification database K091160. Retrieved March 18, 2011 from http://www.fda.gov.

U.S. Food and Drug Administration. (2009, May). Center for Devices and Radiological Health. 510(k) Premarket notification database K091934. Retrieved March 18, 2011 from http://www.fda.gov.

U.S. Food and Drug Administration. (2009, May). Center for Devices and Radiological Health. 510(k) Premarket notification database K092365. Retrieved March 18, 2011 from http://www.fda.gov.

Winifred S. Hayes, Inc. Medical Technology Directory. (2014, December; last update search November 2017). Virtual bronchoscopic navigation for evaluation of peripheral pulmonary lesions. Retrieved January 26, 2018 from www.hayesinc.com.  (33 articles and/or guidelines reviewed)

Zhang, W., Chen, S., Dong, X., & Lei, P. (2015). Meta-analysis of the diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules. Journal of Thoracic Disease, 7 (5), 799-809. (Level 1 evidence)

ORIGINAL EFFECTIVE DATE:  9/11/2011

MOST RECENT REVIEW DATE:  1/10/2019  

ID_BT

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