Thiboutot Jeffrey, Argento A Christine, Akulian Jason, Lee Hans J, DeMaio Andrew, Kapp Christopher M, Wahidi Momen M, Yarmus Lonny
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Respiration. 2022;101(5):485-493. doi: 10.1159/000522514. Epub 2022 Mar 28.
Despite recent advances in guided bronchoscopy, the yield of bronchoscopic biopsy of a peripheral pulmonary nodule (PPN) remains highly variable.
The aim of the study was to evaluate which features of robotic assisted bronchoscopy (RAB) contribute to a successful biopsy in a cadaver model.
A preclinical, prospective, single-blinded trial using a ventilated human cadaveric model assessed the successful puncture of implanted pulmonary nodules using various localization techniques with RAB. The different approaches included positioning the robotic catheter at predefined distances from the target nodule (<10 mm, 10-20 mm, 20-30 mm), bronchoscopist correction of divergence between the software virtual map and bronchoscopic view if observed, and impact of fluoroscopy and radial endobronchial ultrasound (rEBUS). The primary endpoint was a central target hit (defined as an inner 2/3 target puncture) verified by cone-beam computed tomography.
Thirty-eight RAB procedures were performed to target 16 PPNs. Median nodule size was 16.2 mm. All targets were located in the outer 1/3 of the lung with a bronchus sign in 31.3%. Central target hit rates were improved when the robotic catheter tip was closer to the nodule (<10 mm 68%, 10-20 mm 66%, 20-30 mm 11%, p < 0.001). Multivariable analysis confirmed the strongest predictor of a central target hit was robotic catheter distance to nodule (OR 0.89 per increase in 1 mm, p < 0.001), independent of the presence of a bronchus sign, divergence or concentric rEBUS view.
Utilizing a RAB platform, closer proximity of the robotic catheter to the target nodule results in an increase in peripheral nodule biopsy success.
尽管在引导支气管镜检查方面取得了最新进展，但外周肺结节（PPN）的支气管镜活检阳性率仍然差异很大。
本研究的目的是评估机器人辅助支气管镜检查（RAB）的哪些特征有助于在尸体模型中成功进行活检。
一项使用通气人体尸体模型的临床前、前瞻性、单盲试验，评估了使用RAB的各种定位技术对植入肺结节的成功穿刺。不同的方法包括将机器人导管放置在距目标结节预定距离处（<10mm、10 - 20mm、20 - 30mm），如果观察到软件虚拟地图与支气管镜视图之间存在偏差，由支气管镜检查人员进行校正，以及荧光透视和径向支气管内超声（rEBUS）的影响。主要终点是通过锥形束计算机断层扫描验证的中心靶点命中（定义为靶点内2/3穿刺）。
共进行了38例RAB手术，针对16个PPN。结节中位数大小为16.2mm。所有靶点均位于肺的外1/3，其中31.3%有支气管征。当机器人导管尖端更靠近结节时，中心靶点命中率提高（<10mm为68%，10 - 20mm为66%，20 - 30mm为11%，p<0.001）。多变量分析证实，中心靶点命中的最强预测因素是机器人导管到结节的距离（每增加1mm，OR为0.89，p<0.001），与支气管征、偏差或同心rEBUS视图的存在无关。
利用RAB平台，机器人导管更靠近目标结节可提高外周结节活检的成功率。
