Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of Jena, Strasse des Friedens 122, D-07548 Gera, Germany.
Eur J Med Res. 2014 Jan 7;19(1):1. doi: 10.1186/2047-783X-19-1.
High-intensity focused ultrasound is a valuable tool for minimally invasive tumour ablation. However, due to the air content in ventilated lungs, lung tumours have never been treated with high-intensity focused ultrasound. Lung flooding enables efficient lung sonography and tumour imaging in ex vivo human and in vivo porcine lung cancer models. The current study evaluates the effectiveness of lung flooding and sonography-guided high-intensity focused ultrasound for lung tumour ablation in ex vivo human and in vivo animal models.
Lung flooding was performed in four human lung lobes which were resected from non-small cell lung cancers. B-mode imaging and temperature measurements were simultaneously obtained during high-intensity focused ultrasonography of centrally located lung cancers. The tumour was removed immediately following insonation and processed for nicotinamide adenine dinucleotide phosphate-diaphorase and H&E staining. In addition, the left lungs of three pigs were flooded. Purified BSA in glutaraldehyde was injected centrally into the left lower lung lobe to simulate a lung tumour. The ultrasound was focused transthoracically through the flooded lung into the simulated tumour with the guidance of sonography. The temperature of the tumour was simultaneously measured. The vital signs of the animal were monitored during the procedure.
A well-demarcated lesion of coagulation necrosis was produced in four of four human lung tumours. There did not appear to be any damage to the surrounding lung parenchyma. After high-intensity focused ultrasound insonation, the mean temperature increase was 7.5-fold higher in the ex vivo human tumour than in the flooded lung tissue (52.1 K ± 8.77 K versus 7.1 K ± 2.5 K). The transthoracic high-intensity focused ultrasound of simulated tumours in the in vivo model resulted in a mean peak temperature increase up to 53.7°C (±4.5). All of the animals survived the procedure without haemodynamic complications.
High-intensity focused ultrasound with lung flooding produced a thermal effect in an ex vivo human lung carcinoma and in vivo simulated lung tumours in a porcine model. High-intensity focused ultrasound is a potential new strategy for treating lung cancer.
高强度聚焦超声是一种用于微创肿瘤消融的有价值的工具。然而，由于通气肺中的含气量，肺肿瘤从未接受过高强度聚焦超声治疗。肺积水使离体人和活体猪肺癌模型中的肺超声检查和肿瘤成像变得高效。本研究评估了肺积水和超声引导高强度聚焦超声在离体人和活体动物模型中用于肺肿瘤消融的效果。
对从非小细胞肺癌切除的四个肺叶进行肺积水。在对中央型肺癌进行高强度聚焦超声治疗时，同时获得 B 型成像和温度测量。在照射后立即切除肿瘤，并进行烟酰胺腺嘌呤二核苷酸磷酸二氢酶和 H&E 染色处理。此外，对三只猪的左肺进行了注水。将纯化的 BSA 用戊二醛注入左肺下叶的中央模拟肺肿瘤。在超声引导下，将超声聚焦穿过注水的肺进入模拟肿瘤。同时测量肿瘤的温度。在手术过程中监测动物的生命体征。
在四个离体人肺肿瘤中，有四个产生了明确界定的凝固性坏死病灶。周围肺实质似乎没有任何损伤。高强度聚焦超声照射后，离体人肿瘤中的平均温度升高是注水肺组织的 7.5 倍（52.1 K ± 8.77 K 比 7.1 K ± 2.5 K）。在活体模型中模拟肿瘤的经胸高强度聚焦超声导致平均峰值温度升高至 53.7°C（±4.5）。所有动物均在没有血流动力学并发症的情况下完成了手术。
肺积水联合高强度聚焦超声在离体人肺癌和活体猪模拟肺肿瘤中产生了热效应。高强度聚焦超声是治疗肺癌的一种有潜力的新策略。
