锥形束计算机断层扫描引导下的细/超薄支气管镜检查用于诊断周围型肺结节：一项前瞻性初步研究。
Cone beam computed tomography-guided thin/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: a prospective pilot study.
作者信息
Casal Roberto F, Sarkiss Mona, Jones Aaron K, Stewart John, Tam Alda, Grosu Horiana B, Ost David E, Jimenez Carlos A, Eapen George A
机构信息
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Anesthesiology and Preoperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
J Thorac Dis. 2018 Dec;10(12):6950-6959. doi: 10.21037/jtd.2018.11.21.
BACKGROUND
Despite advances in bronchoscopy, its diagnostic yield for peripheral lung lesions continues to be suboptimal. Cone beam computed tomography (CBCT) could be utilized to corroborate the accuracy of our bronchoscopic navigation and hopefully increase its diagnostic yield. However, data on radiation exposure and feasibility of CBCT-guided bronchoscopy is scarce.
METHODS
Prospective pilot study of bronchoscopy for peripheral lung nodules under general anesthesia with thin/ultrathin bronchoscope, radial-probe endobronchial ultrasound (RP-EBUS), and CBCT. Main objective was to estimate radiation dose and secondary objective was the additional value of CBCT in terms of navigational and diagnostic yield.
RESULTS
A total of 20 patients were enrolled. Median lesion size was 2.1 (range, 1.1-3) cm and distance from pleura was 2.1 (range, 0-2.8) cm. "Bronchus sign" was present in 12 (60%) of the lesions. Totally, 12 lesions (60%) were invisible on fluoroscopy. CBCT identified atelectasis obscuring the target in 4 cases (20%). Eleven patients (55%) underwent 1 CBCT scan and 9 patients (45%) 2. The mean estimated effective dose (E) to patients resulting from CBCT ranged between 8.6 and 23 mSv, depending on utilized conversion factors. Both pre-CBCT navigation and diagnostic yield were 50%. Additional post-CBCT maneuvers increased navigation yield to 75% (P=0.02) and diagnostic yield to 70% (P=0.04). One patient developed a pneumothorax.
CONCLUSIONS
CBCT-guided bronchoscopy is associated with an acceptable radiation dose. CBCT may potentially increase both navigation and diagnostic yield of thin/ultrathin bronchoscopy for peripheral lung nodules. The above findings as well as the incidental but relevant finding of intra-procedural atelectasis need to be confirmed in larger prospective studies.
TRIAL REGISTRATION
This study is registered in ClinicalTrials.gov as number NCT02978170.
背景
尽管支气管镜检查技术有所进步，但其对周围型肺病变的诊断率仍不尽人意。锥形束计算机断层扫描（CBCT）可用于验证支气管镜导航的准确性，并有望提高其诊断率。然而，关于CBCT引导下支气管镜检查的辐射暴露和可行性的数据却很少。
方法
对在全身麻醉下使用细/超薄支气管镜、径向探头支气管内超声（RP-EBUS）和CBCT检查周围型肺结节进行前瞻性初步研究。主要目标是估计辐射剂量，次要目标是CBCT在导航和诊断率方面的附加价值。
结果
共纳入20例患者。病变的中位大小为2.1（范围1.1 - 3）cm，距胸膜的距离为2.1（范围0 - 2.8）cm。12个（60%）病变存在“支气管征”。共有12个病变（60%）在荧光镜下不可见。CBCT在4例（20%）中发现肺不张掩盖了目标。11例患者（55%）接受了1次CBCT扫描，9例患者（45%）接受了2次。根据所使用的转换因子，CBCT对患者产生的平均估计有效剂量（E）在8.6至23 mSv之间。CBCT前的导航和诊断率均为50%。CBCT后的附加操作使导航率提高到75%（P = 0.02），诊断率提高到70%（P = 0.04）。1例患者发生气胸。
结论
CBCT引导下支气管镜检查的辐射剂量是可接受的。CBCT可能会提高细/超薄支气管镜检查对周围型肺结节的导航和诊断率。上述发现以及术中肺不张这一偶然但相关的发现需要在更大规模的前瞻性研究中得到证实。
试验注册
本研究已在ClinicalTrials.gov注册，注册号为NCT02978170。
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