Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care and CIC-CRB 1404, Rouen, France.
Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care and CIC-CRB 1404, Rouen, France; QuantIF- LITIS EA 4108, IRIB, Rouen University, F-76000, Rouen, France.
Chest. 2018 Feb;153(2):387-394. doi: 10.1016/j.chest.2017.08.016. Epub 2017 Aug 26.
Stereotactic radiotherapy is used to treat peripheral lung cancer in inoperable patients. Placement of fiducial gold markers (FMs) is crucial for tracking small lesions that are not visible on chest radiographs. Our objective was to assess endoscopic FM placement in small peripheral lung nodules (PLNs) that are not trackable using automated tracking software.
All patients benefiting from virtual bronchoscopy and radial endobronchial ultrasonography (R-EBUS)-guided placement of FMs for PLNs < 20 mm were included. After confirmation by biopsy sampling, a gold-seed FM was inserted into the nodule using a bronchial brush, without the use of fluoroscopy. The performance and complications of the procedure were recorded.
From May 2010 to June 2015, FMs were placed in the PLNs of 54 consecutive patients, 34 of whom presented with a nodule < 20 mm. Seventy-six percent of the procedures were performed using local anesthesia on an outpatient basis. The median long- and short-axis diameters of nodules were 15 mm (9-20 mm) and 11 mm (6-20 mm), respectively, with 31 of 34 nodules exhibiting a short axis of < 15 mm. In 23 cases (79%), histologic samples were obtained during the procedure that allowed FM placement. Migration occurred in six cases, including two in the hours following the procedure. FMs were in place and visible on CT imaging performed 3 months after radiation therapy in 80% of cases. No complications were reported.
Diagnosis of peripheral nodules < 20 mm and FM placement using R-EBUS are efficient and safe in a single procedure.
立体定向放疗用于治疗无法手术的周围型肺癌患者。放置基准金标记物（FMs）对于跟踪胸部 X 光片上不可见的小病变至关重要。我们的目的是评估无法使用自动跟踪软件跟踪的小周围型肺结节（PLNs）中内镜 FM 放置的情况。
所有受益于虚拟支气管镜和径向支气管内超声（R-EBUS）引导 PLNs < 20mm FM 放置的患者均被纳入。在活检采样确认后，使用支气管刷将金种子 FM 插入结节内，无需透视。记录手术的性能和并发症。
从 2010 年 5 月至 2015 年 6 月，54 例连续患者的 PLNs 中放置了 FM，其中 34 例患者的结节 < 20mm。76%的手术在局麻下门诊进行。结节的长轴和短轴直径中位数分别为 15mm（9-20mm）和 11mm（6-20mm），34 个结节中有 31 个短轴 < 15mm。在 23 例（79%）中，在手术过程中获得了组织学样本，允许放置 FM。6 例发生迁移，其中 2 例在术后数小时内发生。在 80%的病例中，在放疗后 3 个月进行的 CT 成像上 FM 仍在位且可见。未报告并发症。
R-EBUS 引导下对直径 < 20mm 的周围结节的诊断和 FM 放置在单一操作中是有效和安全的。
