Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Semin Thorac Cardiovasc Surg. 2020;32(3):570-578. doi: 10.1053/j.semtcvs.2020.02.003. Epub 2020 Feb 10.
Radiofrequency ablation (RFA) can be a therapeutic option in medically inoperable lung cancer patients. In this study, we evaluated a prototype bipolar RFA device applicator that can be deployed from a standard endobronchial ultrasound (EBUS) bronchoscope to determine feasibility and histopathological analysis in animal models. Rabbit lung cancers were created by transbronchial injection of VX2 rabbit cancer cells. Once the tumors were developed, they were ablated transpleurally, under EBUS guidance using the prototype RFA device. The animals were then sacrificed for specimen resection. Pig inflammatory lung pseudo-tumors and lymphadenopathy were created by transbronchial injection of a talc paste and ablated transbronchially under EBUS guidance. Pigs were evaluated at 5 days, 2 weeks, and 4 weeks following ablation by bronchoscopy and cone beam computed tomography before necropsy. Nicotinamide adenine dinucleotide hydrogen diaphorase staining was employed to measure the ablation area. Twenty-four VX2 rabbit tumors were ablated. The total ablated area ranged from 0.6 to 3.0 cm (mean: 1.8 cm), corresponding to a total energy range of 1 to 6 kJ. Six pig lung pseudo-tumors and 5 mediastinal lymph nodes were ablated. Adjacent airway ulceration was observed in 3 ablations of lymph nodes. These airway complications resolved within 4 weeks of RFA without any treatment. There was no hemoptysis, air embolism, respiratory distress, or other serious complication noted. In these 2 animal models, we provide evidence that EBUS-guided bipolar RFA is feasible and histopathology shows that can ablate lung tumors and mediastinal lymph nodes under real-time ultrasound guidance.
射频消融 (RFA) 可以成为无法手术的肺癌患者的一种治疗选择。在这项研究中，我们评估了一种可从标准支气管内超声 (EBUS) 支气管镜部署的原型双极 RFA 设备应用器，以确定其在动物模型中的可行性和组织病理学分析。通过经支气管注射 VX2 兔癌细胞在兔肺中创建肺癌。一旦肿瘤发展，就在 EBUS 引导下经胸膜外使用原型 RFA 设备进行消融。然后，处死动物进行标本切除。通过经支气管注射滑石粉在猪中创建炎症性肺假性肿瘤和淋巴结病，并在 EBUS 引导下经支气管进行消融。在消融后 5 天、2 周和 4 周通过支气管镜和锥形束计算机断层扫描评估猪，然后在尸检前进行。使用烟酰胺腺嘌呤二核苷酸氢二磷酸酶染色来测量消融面积。消融了 24 个 VX2 兔肿瘤。总消融面积范围为 0.6 至 3.0 cm（平均值：1.8 cm），对应的总能量范围为 1 至 6 kJ。消融了 6 个猪肺假性肿瘤和 5 个纵隔淋巴结。在 3 次淋巴结消融中观察到相邻气道溃疡。这些气道并发症在 RFA 后 4 周内无需治疗即可自行消退。没有出现咯血、空气栓塞、呼吸窘迫或其他严重并发症。在这两种动物模型中，我们提供了证据表明 EBUS 引导下的双极 RFA 是可行的，组织病理学显示可以在实时超声引导下消融肺肿瘤和纵隔淋巴结。
