Palumbo Rachael, Sarwar Zoona, Stewart Kenneth E, Garwe Tabitha, Reinersman J Matthew
Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
J Surg Res. 2022 Jun;274:248-253. doi: 10.1016/j.jss.2022.01.025. Epub 2022 Feb 23.
With the advent of lung cancer screening, lung nodules are being discovered at an increasing rate. With improvements in transbronchial biopsy technology, it is important for thoracic surgeons to be involved with diagnostic procedures. The aim of this project is to relate the thoracic surgeon experience in implementing an electromagnetic navigational bronchoscopy (ENB) program at our institution and describe the factors that led to successful navigation (the ability to position a biopsy instrument in range for biopsy) and diagnostic biopsy of nodules.
The thoracic surgery ENB program was initiated in 2014. A retrospective analysis of patients referred to thoracic surgery from 2014 to 2019 for lung nodule evaluation was performed. Patients who underwent ENB and biopsy were included. Recursive partitioning (CART) and multivariable regression analyses were used to identify predictors of successful navigation and biopsy.
There were 73 patients who underwent ENB evaluation of 91 nodules from 2014 to 2019. There was successful navigation in 75.8% of nodules, and on multivariable analysis, bronchus sign, lesion size, and pleural distance were significant predictors of successful navigation. Of the lesions that had successful navigation, 65.2% had a diagnostic biopsy. Based on CART analysis, positive bronchus sign and lesion size ≥ 1.3 cm were most predictive of obtaining a diagnostic biopsy with a probability of 0.75.
Nodule size, distance to the pleura, and bronchus size are independent variables of successful navigation when using ENB. However, of the lesions that were successfully reached, combined lesion size >1.3 cm and a positive bronchus sign were most predictive of obtaining a diagnostic biopsy. These factors should be considered when implementing an ENB program in a thoracic surgery practice.
随着肺癌筛查的出现，肺结节的发现率越来越高。随着经支气管活检技术的改进，胸外科医生参与诊断程序很重要。本项目的目的是阐述胸外科医生在我们机构实施电磁导航支气管镜检查（ENB）计划的经验，并描述导致成功导航（将活检器械定位在活检范围内的能力）和结节诊断性活检的因素。
胸外科ENB计划于2014年启动。对2014年至2019年转诊至胸外科进行肺结节评估的患者进行回顾性分析。纳入接受ENB和活检的患者。采用递归划分（CART）和多变量回归分析来确定成功导航和活检的预测因素。
2014年至2019年，有73例患者接受了对91个结节的ENB评估。75.8%的结节实现了成功导航，多变量分析显示，支气管征、病变大小和胸膜距离是成功导航的重要预测因素。在成功导航的病变中，65.2%获得了诊断性活检。基于CART分析，阳性支气管征和病变大小≥1.3 cm最能预测获得诊断性活检，概率为0.75。
使用ENB时，结节大小、与胸膜的距离和支气管大小是成功导航的独立变量。然而，在成功到达的病变中，联合病变大小>1.3 cm和阳性支气管征最能预测获得诊断性活检。在胸外科实践中实施ENB计划时应考虑这些因素。
