在高危人群中进行长时间支气管镜检查（包括肺癌诊断、系统性淋巴结分期和基准标志物放置）的安全性和可行性。
Safety and feasibility of prolonged bronchoscopy involving diagnosis of lung cancer, systematic nodal staging, and fiducial marker placement in a high-risk population.
作者信息
Kular Harman, Mudambi Lakshmi, Lazarus Donald R, Cornwell Lorraine, Zhu Angela, Casal Roberto F
机构信息
1 Section of Pulmonary and Critical Care Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA ; 2 Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA ; 3 Division of Cardiothoracic Surgery, Michael E. DeBakey, Department of Surgery, 4 Department of Radiation Oncology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA.
出版信息
J Thorac Dis. 2016 Jun;8(6):1132-8. doi: 10.21037/jtd.2016.04.06.
BACKGROUND
Stereotactic body radiation therapy (SBRT) is considered the standard treatment for medically inoperable early stage lung cancer. Bronchoscopy has shown to be effective in obtaining diagnosis of peripheral lung tumors, staging the mediastinum (with endobronchial ultrasound- EBUS-), and placing fiducial markers (FMs). However, the combination of these 3 procedures in a single bronchoscopy has not been studied. The aim of this study is to describe safety and feasibility of performing diagnosis, systematic nodal staging, and placement of FMs in a single bronchoscopic procedure.
METHODS
Retrospective review of patients who underwent bronchoscopy with diagnosis of peripheral lung cancer, EBUS for nodal staging, and FM placement in a single procedure at Michael E. DeBakey VA Medical Center between January 2011 and July 2015.
RESULTS
Twenty-one patients met our criteria, one having 2 synchronous tumors. 95% of patients had an ASA score of at least 3. Twenty-two tumors were diagnosed with a size of 2.72±1.06 cm. Distance from pleura was 1.33±1.42 cm. Median duration of bronchoscopy was 96 minutes (range, 75 to 136 minutes). Guided-bronchoscopy provided diagnosis of lung cancer in all cases. Fluoroscopy and RP-EBUS were utilized in 21 patients, "hybrid" scope in 14, and electromagnetic navigational bronchoscopy in 3. A total of 100 lymph nodes (LN) were sampled with EBUS-TBNA, with 95% of the patients having at least 4 LN sampled. A total of 71 FM were placed for 22 tumors. All markers were retained and allowed for successful SBRT. There were no pneumothoraces and no major complications.
CONCLUSIONS
Although it results in lengthy procedures, a single bronchoscopy obtaining diagnosis of peripheral lung nodules, systematic nodal staging, and FM placement can be safely performed in high-risk patients. Our "all-in-one" strategy could potentially expedite treatment, decrease complications, and reduce costs. Further prospective studies are needed to corroborate our findings.
背景
立体定向体部放射治疗（SBRT）被认为是医学上无法手术的早期肺癌的标准治疗方法。支气管镜检查已被证明在获取周围型肺肿瘤的诊断、纵隔分期（通过支气管内超声引导-EBUS-）以及放置基准标记物（FMs）方面是有效的。然而，在单次支气管镜检查中联合这三种操作尚未得到研究。本研究的目的是描述在单次支气管镜检查过程中进行诊断、系统性淋巴结分期和放置FMs的安全性和可行性。
方法
回顾性分析2011年1月至2015年7月在迈克尔·E·德贝基退伍军人事务医疗中心接受单次支气管镜检查的患者，这些检查包括周围型肺癌的诊断、EBUS进行淋巴结分期以及FMs放置。
结果
21例患者符合我们的标准，其中1例有2个同步肿瘤。95%的患者美国麻醉医师协会（ASA）评分至少为3分。22个肿瘤被诊断出来，大小为2.72±1.06厘米。距胸膜的距离为1.33±1.42厘米。支气管镜检查的中位持续时间为96分钟（范围为75至136分钟）。引导支气管镜检查在所有病例中均提供了肺癌诊断。21例患者使用了荧光镜检查和实时虚拟导航EBUS，14例使用了“混合”支气管镜，3例使用了电磁导航支气管镜。总共通过EBUS-TBNA对100个淋巴结（LN）进行了采样，95%的患者至少采样了4个LN。总共为22个肿瘤放置了71个FMs。所有标记物均保留并使SBRT得以成功进行。没有发生气胸，也没有严重并发症。
结论
尽管单次支气管镜检查过程较长，但在高危患者中可以安全地进行单次支气管镜检查以获得周围型肺结节的诊断、系统性淋巴结分期和FMs放置。我们的“一体化”策略可能会加快治疗速度、减少并发症并降低成本。需要进一步的前瞻性研究来证实我们的发现。
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