电磁导航支气管镜术结合断层成像可视化和位置校正：锥形束计算机断层扫描证实的三维准确性。
Electromagnetic Navigation Bronchoscopy With Tomosynthesis-based Visualization and Positional Correction: Three-dimensional Accuracy as Confirmed by Cone-Beam Computed Tomography.
机构信息
FirstHealth of the Carolinas and Pinehurst Medical Clinic, Pinehurst, NC.
CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN.
出版信息
J Bronchology Interv Pulmonol. 2021 Jan 1;28(1):10-20. doi: 10.1097/LBR.0000000000000687.
BACKGROUND
Electromagnetic navigation bronchoscopy (ENB) aids in lung lesion biopsy. However, anatomic divergence between the preprocedural computed tomography (CT) and the actual bronchial anatomy during the procedure can limit localization accuracy. An advanced ENB system has been designed to mitigate CT-to-body divergence using a tomosynthesis-based software algorithm that enhances nodule visibility and allows for intraprocedural local registration.
MATERIALS AND METHODS
A prospective, 2-center study was conducted in subjects with single peripheral lung lesions ≥10 mm to assess localization accuracy of the superDimension navigation system with fluoroscopic navigation technology. Three-dimensional accuracy was confirmed by cone-beam computed tomography. Complications were assessed through 7 days.
RESULTS
Fifty subjects were enrolled (25 per site). Lesions were <20 mm in 61.2% (30/49). A bronchus sign was present in 53.1% (26/49). Local registration was completed in 95.9% (47/49). Three-dimensional target overlap (primary endpoint) was achieved in 59.6% (28/47) and 83.0% (39/47) before and after location correction, respectively. Excluding subjects with unevaluable video files, target overlap was achieved 68.3% (28/41) and 95.1% (39/41), respectively. Malignant results were obtained in 53.1% (26/49) by rapid on-site evaluation and 61.2% (30/49) by final pathology of the ENB-aided sample. Diagnostic yield was not evaluated. Procedure-related complications were pneumothorax in 1 subject (no chest tube required) and scant hemoptysis in 3 subjects (no interventions required).
CONCLUSION
ENB with tomosynthesis-based fluoroscopic navigation improved the 3-dimensional convergence between the virtual target and actual lung lesion as confirmed by cone-beam computed tomography. Future studies are necessary to understand the impact of this technology on diagnostic yield.
背景
电磁导航支气管镜（ENB）有助于肺病变活检。然而，术前计算机断层扫描（CT）和手术过程中实际支气管解剖结构之间的解剖学差异会限制定位准确性。一种先进的 ENB 系统已被设计用来减轻 CT 与身体之间的发散，使用基于断层合成的软件算法来增强结节的可见度，并允许术中局部注册。
材料和方法
在 50 名具有单个外周肺病变≥10mm 的受试者中进行了一项前瞻性、双中心研究，以评估带有荧光导航技术的 superDimension 导航系统的定位准确性。通过锥形束计算机断层扫描确认三维准确性。通过 7 天评估并发症。
结果
共纳入 50 名受试者（每个中心 25 名）。病变<20mm 的占 61.2%（49 例中的 30 例）。支气管征的出现率为 53.1%（49 例中的 26 例）。95.9%（49 例中的 47 例）完成了局部注册。三维目标重叠（主要终点）分别在定位校正前后达到 59.6%（47 例中的 28 例）和 83.0%（47 例中的 39 例）。排除视频文件不可评估的受试者后，分别达到 68.3%（41 例中的 28 例）和 95.1%（41 例中的 39 例）。快速现场评估的恶性结果为 53.1%（49 例中的 26 例），ENB 辅助样本的最终病理学结果为 61.2%（49 例中的 30 例）。未评估诊断率。与操作相关的并发症包括 1 例气胸（无需放置胸腔引流管）和 3 例少量咯血（无需介入治疗）。
结论
基于断层合成的荧光导航的 ENB 提高了虚拟目标和实际肺病变之间的三维收敛性，这一点通过锥形束计算机断层扫描得到了证实。需要进一步的研究来了解这项技术对诊断率的影响。
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