Long-term Diagnostic Yield for Navigational Bronchoscopy: Analysis of Over 600 Procedures

<bold>Objective:</bold> This study aimed to assess the long-term diagnostic efficacy of navigational bronchoscopy as a tool for identifying lung lesions. The primary focus was on evaluating the procedure's diagnostic accuracy, with secondary outcomes examining pneumothorax rates, need for drain insertion, and hospital stay duration. <bold>Methods:</bold> A retrospective analysis of navigational bronchoscopy procedures conducted by multiple surgeons between 2018 and 2022 was undertaken. We particularly perform the cases unsuitable for routine diagnostic methods or those failed by conventional modalities. Diagnostic accuracy, based on pathology from per-lesion biopsies, was evaluated. Long-term accuracy was confirmed through follow-up CT scans and treatments for at least one year post-procedure. Post-procedural complications and hospital stay durations were also assessed. <bold>Results:</bold> During the study period, 603 procedures were conducted, with a 59% diagnostic accuracy per lesion biopsied. Notably, when analysed across various surgeons with a minimum experience of 30 procedures, diagnostic efficacy ranged between 54% and 67%. True positive identification occurred in 38% of cases, while true negatives accounted for 21%. Pneumothorax incidence was 7%, with drain insertion needed in 3% of cases. The mean hospital stay was 0.51 days, with 399 patients discharged on the day of surgery. <bold>Conclusion:</bold> Our extensive experience demonstrates navigational bronchoscopy's significant diagnostic accuracy in identifying lung lesions, especially in cases unsuitable for routine diagnostic methods. Despite the occurrence of pneumothorax, the procedure showcases effectiveness through notably brief post-procedural hospital stays.