Ghosn Mario, Elsakka Ahmed S, Ridouani Fourat, Doustaly Raphael, Mingione Louie, Royalty Kevin, Ziv Etay, Alexander Erica, Maxwell Aaron, Monette Sebastien, Kim Hyun S, Short Robert F, Tam Alda Lui, Suh Robert D, Solomon Stephen B
Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
GE Healthcare, Buc, France.
Transl Lung Cancer Res. 2022 Feb;11(2):150-164. doi: 10.21037/tlcr-21-864.
Transbronchial microwave ablation (MWA) is a promising novel therapy. Despite advances in bronchoscopy and virtual navigation, real time image guidance of probe delivery is lacking, and distal maneuverability is limited. Cone-beam computed tomography (CBCT) based augmented fluoroscopy guidance using steerable sheaths may help overcome these shortcomings. The aim of this study was to evaluate feasibility and accuracy of augmented fluoroscopy guided transbronchial MWA with a steerable sheath and without a bronchoscope.
In this prospective study, procedures were performed under general anesthesia. Extra-bronchial lung synthetic targets were placed percutaneously. Target and airways extracted from CBCT, with planned bronchial parking point close to the target were overlaid on live fluoroscopy. Endobronchial navigation was solely performed under augmented fluoroscopy guidance. A 6.5 Fr steerable sheath was parked in the bronchus per plan, and a flexible MWA probe was inserted coaxially then advanced through the bronchus wall towards the target. Final in-target position was confirmed by CBCT. Only one ablation of 100 W-5 min was performed per target. Animals were euthanized and pathology analysis of the lungs was performed.
Eighteen targets with a median largest diameter of 9 mm (interquartile range, 7-11 mm) were ablated in 9 pigs. Median needle-target center distance was 2 mm (interquartile range, 0-4 mm), and was higher for lower/middle than for upper lobes [0 mm (interquartile range, 0-4 mm) 4 mm (interquartile range, 3-8 mm), P=0.04]. No severe complications or pneumothorax occurred. Two cases of rib fractures in the ablation zone resolved after medical treatment. Median longest axis of the ablation zone on post-ablation computed tomography was 38 mm (interquartile range, 30-40 mm). Histology showed coagulation necrosis of ablated tissue.
Transbronchial MWA under augmented fluoroscopy guidance using a steerable sheath is feasible and accurate.
经支气管微波消融术（MWA）是一种很有前景的新型治疗方法。尽管支气管镜检查和虚拟导航技术取得了进展，但在探头输送的实时图像引导方面仍存在不足，并且远端可操作性有限。基于锥形束计算机断层扫描（CBCT）的使用可操纵鞘管的增强透视引导可能有助于克服这些缺点。本研究的目的是评估在不使用支气管镜的情况下，使用可操纵鞘管进行增强透视引导下经支气管MWA的可行性和准确性。
在这项前瞻性研究中，手术在全身麻醉下进行。经皮放置支气管外肺合成靶点。从CBCT中提取靶点和气道，并将计划的靠近靶点的支气管停泊点叠加在实时透视上。仅在增强透视引导下进行支气管内导航。按照计划将一个6.5 Fr的可操纵鞘管停泊在支气管中，然后同轴插入一个柔性MWA探头，接着将其穿过支气管壁向靶点推进。通过CBCT确认最终的靶点内位置。每个靶点仅进行一次100 W - 5分钟的消融。对动物实施安乐死并进行肺部病理分析。
在9头猪身上消融了18个靶点，最大直径中位数为9 mm（四分位间距，7 - 11 mm）。针与靶点中心距离中位数为2 mm（四分位间距，0 - 4 mm），下叶/中叶高于上叶[0 mm（四分位间距，0 - 4 mm）对4 mm（四分位间距，3 - 8 mm），P = 0.04]。未发生严重并发症或气胸。消融区域内的两例肋骨骨折经治疗后痊愈。消融后计算机断层扫描上消融区域最长轴的中位数为38 mm（四分位间距，30 - 40 mm）。组织学显示消融组织出现凝固性坏死。
在增强透视引导下使用可操纵鞘管进行经支气管MWA是可行且准确的。
