Katsis James, Roller Lance, Aboudara Matthew, Pannu Jasleen, Chen Heidi, Johnson Joyce, Lentz Robert J, Rickman Otis, Maldonado Fabien
Division of Allergy, Pulmonary and Critical Care Medicine.
Division of Pulmonary Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
J Bronchology Interv Pulmonol. 2021 Oct 1;28(4):255-261. doi: 10.1097/LBR.0000000000000766.
Navigational bronchoscopy is commonly used to sample lung nodules, with a better safety profile but lower diagnostic yield than computerized tomography-guided transthoracic needle biopsy. The addition of digital tomosynthesis to electromagnetic navigation, using intraprocedural images obtained from a C-arm fluoroscope to identify target lesion location and update navigational guidance, may improve diagnostic yield.
Consecutive bronchoscopies using tomosynthesis-assisted fluoroscopic electromagnetic navigational bronchoscopy (F-ENB) at a single institution over a 1-year period were included. The primary outcome was diagnostic yield. A bronchoscopy was defined as diagnostic if pathologic examination revealed malignancy or specific histological findings indicative of lesional sampling with confirmatory 6-month follow-up for benign lesions.
A total of 324 patients with 363 nodules underwent F-ENB between April 25, 2018 and April 29, 2019. The average nodule size was 1.9±1.1 cm, 65% of the nodules were located in the peripheral third of the lung. A bronchus sign was present in 24% of cases. Of the 363 nodules, 299 (82.4%) had lesional findings. At 6-month follow-up, among these 299 nodules, 6 were found to be false negatives and 12 nodules were lost to follow-up. Considering all nodules lost to follow-up as false negatives, the 6-month diagnostic yield was 77.4%. Pneumothorax complicated 8 (2.5%) of cases. There was 1 episode of respiratory failure.
This retrospective study suggests the diagnostic yield of F-ENB may exceed that of traditional ENB. Future prospective and comparative studies are needed to confirm these promising data.
导航支气管镜检查常用于肺结节取样，与计算机断层扫描引导下的经胸针吸活检相比，其安全性更高，但诊断率较低。在电磁导航中加入数字断层合成技术，利用从C形臂荧光透视仪获得的术中图像来识别目标病变位置并更新导航引导，可能会提高诊断率。
纳入在一家机构进行为期1年的连续支气管镜检查，采用断层合成辅助荧光透视电磁导航支气管镜检查（F-ENB）。主要结局是诊断率。如果病理检查显示为恶性或有特定组织学发现，提示病变取样且对良性病变进行6个月的随访确认，则支气管镜检查被定义为诊断性检查。
2018年4月25日至2019年4月29日期间，共有324例患者的363个结节接受了F-ENB检查。结节平均大小为1.9±1.1厘米，65%的结节位于肺外周三分之一处。24%的病例存在支气管征。在363个结节中，299个（82.4%）有病变发现。在6个月的随访中，在这299个结节中，发现6个为假阴性，12个结节失访。将所有失访结节视为假阴性，6个月的诊断率为77.4%。8例（2.5%）病例并发气胸。发生1次呼吸衰竭。
这项回顾性研究表明，F-ENB的诊断率可能超过传统ENB。需要未来的前瞻性和对比研究来证实这些有前景的数据。
