Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Hsinchu City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan.
J Formos Med Assoc. 2019 Aug;118(8):1232-1238. doi: 10.1016/j.jfma.2019.04.017. Epub 2019 May 13.
BACKGROUND/PURPOSE: Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) for use in guiding endobronchial dye marking of small pulmonary nodules prior to thoracoscopic surgery is still under development. We sought to evaluate the effect of the cumulative experience on procedural parameters of CBCT-AF-guided endobronchial dye marking for preoperative localization of small pulmonary nodules.
Clinical variables and treatment outcomes of the 30 initial patients with small pulmonary nodules who were managed with CBCT-AF-guided endobronchial dye marking followed by thoracoscopic resection in our institution were analyzed. Two sequential groups of patients (group I and group II, n = 15 each) were compared with regard to localization time and radiation doses. The Mann-Whitney U test and chi-square test or Fisher exact test were used in the statistical analyses.
In the entire cohort, the median size of solitary pulmonary nodules on preoperative computed tomography (CT) images was 9.3 mm (interquartile range, 7.4-13.6 mm), and their median distance from the pleural surface was 15.2 mm (interquartile range, 10.3-27.1 mm). The median tumor depth-to-size ratio was 1.6 (interquartile range, 1.1-2.3). A significant reduction in single DynaCT radiation (3690.4 versus [vs.] 1132.3 μGym; P < 0.001) and total radiation exposure (median, 4878.8 vs. 1673.8 μGym; P < 0.001) was noted in group II (late patients) compared with group I.
Our initial results of CBCT-AF-guided lung marking demonstrate that the cumulative experience with several technical modifications can achieve the same purpose of endobronchial localization with less procedure-related radiation exposure.
背景/目的：在胸腔镜手术前，利用锥形束计算机断层扫描（CBCT）衍生的增强透视（CBCT-AF）引导支气管内染料标记小肺结节仍在开发中。我们旨在评估在 CBCT-AF 引导的支气管内染料标记小肺结节的术前定位中，累积经验对程序参数的影响。
分析了我院 30 例小肺结节患者接受 CBCT-AF 引导的支气管内染料标记后行胸腔镜切除术的临床变量和治疗结果。比较了两组患者（第 I 组和第 II 组，每组 15 例）的定位时间和辐射剂量。统计分析采用 Mann-Whitney U 检验、卡方检验或 Fisher 确切概率法。
在整个队列中，术前 CT 图像上孤立性肺结节的中位数大小为 9.3mm（四分位距 7.4-13.6mm），距胸膜表面的中位数距离为 15.2mm（四分位距 10.3-27.1mm）。肿瘤深度与大小的中位数比值为 1.6（四分位距 1.1-2.3）。与第 I 组（早期患者）相比，第 II 组（晚期患者）单次 DynaCT 辐射（3690.4 与 1132.3μGym；P<0.001）和总辐射暴露（中位数，4878.8 与 1673.8μGym；P<0.001）显著降低。
我们 CBCT-AF 引导的肺标记初始结果表明，通过几项技术改进的累积经验可以达到相同的支气管内定位目的，同时减少与手术相关的辐射暴露。
