Makris D, Scherpereel A, Leroy S, Bouchindhomme B, Faivre J-B, Remy J, Ramon P, Marquette C-H
Clinic of Respiratory Disease, Department of Anatomopathology, Albert Calmette Hospital, Centre Hospitalier Régional University of Lille, 59037 Lille, France.
Eur Respir J. 2007 Jun;29(6):1187-92. doi: 10.1183/09031936.00165306. Epub 2007 Mar 14.
The present study prospectively evaluated the diagnostic yield and safety of electromagnetic navigation-guided bronchoscopy biopsy, for small peripheral lung lesions in patients where standard techniques were nondiagnostic. The study was conducted in a tertiary medical centre on 40 consecutive patients considered unsuitable for straightforward surgery or computed tomography (CT)-guided transthoracic needle aspiration biopsy, due to comorbidities. The lung lesion diameter was mean+/-sem 23.5+/-1.5 mm and the depth from the visceral-costal pleura was 14.9+/-2 mm. Navigation was facilitated by an electromagnetic tracking system which could detect a position sensor incorporated into a flexible catheter advanced through a bronchoscope. Information obtained during bronchoscopy was superimposed on previously acquired CT data. Divergence between CT data and data obtained during bronchoscopy was calculated by the system's software as a measure of navigational accuracy. All but one of the target lesions was reached and the overall diagnostic yield was 62.5% (25-40). Diagnostic yield was significantly affected by CT-to-body divergence; yield was 77.2% when estimated divergence was <or=4 mm. Three pneumothoraces occurred and chest drainage was required in one case. Electromagnetic navigation-guided bronchoscopy has the potential to improve the diagnostic yield of transbronchial biopsies without additional fluoroscopic guidance, and may be useful in the early diagnosis of lung cancer, particularly in nonoperable patients.
本研究前瞻性评估了电磁导航引导下支气管镜活检对于标准技术无法诊断的周围型小肺病变患者的诊断率及安全性。该研究在一家三级医疗中心开展，纳入了40例因合并症而被认为不适合直接手术或计算机断层扫描（CT）引导下经胸针吸活检的连续患者。肺病变直径平均为23.5±1.5毫米，距脏层-肋胸膜的深度为14.9±2毫米。电磁跟踪系统辅助导航，该系统可检测通过支气管镜推进的柔性导管内的位置传感器。支气管镜检查期间获取的信息叠加在先前获取的CT数据上。系统软件计算CT数据与支气管镜检查期间获得的数据之间的差异，作为导航准确性的指标。除一个目标病变外，所有病变均到达，总体诊断率为62.5%（25/40）。CT与身体的差异对诊断率有显著影响；估计差异≤4毫米时，诊断率为77.2%。发生了3例气胸，1例需要胸腔引流。电磁导航引导下支气管镜检查有潜力在无额外荧光透视引导的情况下提高经支气管活检的诊断率，可能有助于肺癌的早期诊断，尤其是在无法手术的患者中。
