Narsule Chaitan K, Sales Dos Santos Ricardo, Gupta Avneesh, Ebright Michael I, Rivas Roberto, Daly Benedict D T, Fernando Hiran C
Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, MA 02118, USA.
Innovations (Phila). 2012 May-Jun;7(3):187-90. doi: 10.1097/IMI.0b013e318265b127.
Electromagnetic (EM) navigation is increasingly used to assist with bronchoscopic interventions such as biopsy or fiducial placement. Electromagnetic navigation can also be a useful adjunct to computed tomography (CT)-guided thermal ablation and biopsy of lung tumors. This study compares procedures carried out using an EM navigation system (Veran Medical Technologies Inc, St Louis, MO) with procedures using CT fluoroscopy only.
Over a 23-month period, 17 patients scheduled for thermal ablation were prospectively enrolled in this study. The mean age was 72 years (range, 60-84 years). Seven patients were women. Patients were randomized to EM navigation (n = 7) or CT fluoroscopy alone (n = 10). In some cases, additional ablation or biopsies were performed with or without EM navigation depending on the randomization arm. All procedures were performed under general anesthesia either by a thoracic surgeon or a radiologist.
A total of 23 procedures were performed in 17 patients: 20 were ablation procedures and 3 were biopsies. Fourteen were performed for non-small cell lung cancer, and 9 for pulmonary metastases from other organs. Despite randomization, patients receiving EM navigation had a trend for smaller tumors (mean diameter, 1.45 vs 2.90 cm; P = 0.06). For thermal ablation procedures, the time to complete intervention was significantly less when EM navigation was used (mean, 7.6 vs 19 minutes; P = 0.022). Although not statistically significant, there were fewer skin punctures (mean, 1 vs 1.25; P = 0.082), fewer adjustments (mean, 5.6 vs 11.8; P = 0.203), less CT fluoroscopy time (mean, 21.3 vs 34.3 seconds; P = 0.345), and fewer CT scans (mean, 7 vs 15; P = 0.204) whenever EM navigation was used.
Electromagnetic navigation reduces the time to successfully place an ablation probe in a target tumor. Further study is required to determine whether EM navigation may also reduce the number of adjustments, skin punctures, and CT scans as well as decrease CT fluoroscopy time.
电磁（EM）导航越来越多地用于辅助支气管镜检查干预，如活检或基准点放置。电磁导航也可作为计算机断层扫描（CT）引导下肺肿瘤热消融和活检的有用辅助手段。本研究比较了使用EM导航系统（Veran Medical Technologies Inc，密苏里州圣路易斯）进行的操作与仅使用CT透视进行的操作。
在23个月的时间里，17例计划进行热消融的患者前瞻性地纳入本研究。平均年龄为72岁（范围60 - 84岁）。7例为女性。患者被随机分为EM导航组（n = 7）或仅CT透视组（n = 10）。在某些情况下，根据随机分组情况，在有或没有EM导航的情况下进行额外的消融或活检。所有操作均在全身麻醉下由胸外科医生或放射科医生进行。
17例患者共进行了23次操作：20次为消融操作，3次为活检。14次针对非小细胞肺癌，9次针对其他器官的肺转移瘤。尽管进行了随机分组，但接受EM导航的患者肿瘤倾向于较小（平均直径，1.45对2.90 cm；P = 0.06）。对于热消融操作，使用EM导航时完成干预的时间明显更短（平均，7.6对19分钟；P = 0.022）。虽然无统计学意义，但使用EM导航时皮肤穿刺次数较少（平均，1对1.25；P = 0.082），调整次数较少（平均，5.6对11.8；P = 0.203），CT透视时间较短（平均，21.3对34.3秒；P = 0.345），CT扫描次数较少（平均，7对15；P = 0.204）。
电磁导航可减少将消融探针成功放置在目标肿瘤中的时间。需要进一步研究以确定电磁导航是否还可减少调整次数、皮肤穿刺次数和CT扫描次数以及缩短CT透视时间。
