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Sampling of Suspicious Solitary Pulmonary Nodules: Electromagnetic Navigational Bronchoscopy and Video-Assisted Thoracoscopic Surgery.

Introduction Inan era of increasing utilization of chest imagingparticularly for lung cancer screening, solitary pulmonary nodules are more prevalent; however,most nodules are notmalignant. The National Lung Screening Trial (NLST), which demonstrated that screening with low-dose computed tomography (CT) resulted in a 20% relative reduction in the rate of death from lung cancer, found that approximately 24% of patients undergoing low-dose CT had a positive screening result. Of these, 90% of patients underwent further diagnostic workup, including further imaging (81%), bronchoscopy (4.3%), surgical procedure (4.2%), or percutaneous biopsy (2.2%). Most nodules found were negative for malignancy, with a 96.4% false-positive rate. Here we discuss the mechanics, limitations, and efficacy of electromagnetic navigational bronchoscopy (ENB) and videoassisted thoracoscopic surgery (VATS) in the diagnosis of solitary pulmonary nodules.