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锥形束 CT 增强电磁导航支气管镜活检不明原因肺结节的疗效和安全性。

Efficacy and Safety of Cone-Beam CT Augmented Electromagnetic Navigation Guided Bronchoscopic Biopsies of Indeterminate Pulmonary Nodules.

机构信息

Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI 53226, USA.

出版信息

Tomography. 2022 Aug 18;8(4):2049-2058. doi: 10.3390/tomography8040172.

Abstract

Bronchoscopic biopsy results for indeterminate pulmonary nodules remain suboptimal. Electromagnetic navigation bronchoscopy (ENB) coupled with cone beam computed tomography (CBCT) for confirmation has the potential to improve diagnostic yield. We present our experience using this multimodal approach to biopsy 17 indeterminate nodules in 14 consecutive patients from April to August 2021. Demographic information, nodule characteristics, and biopsy results were recorded. Procedures were performed in a hybrid operating room equipped with a Siemens Artis Q bi-plane CBCT (Siemens, Munich, Germany). After ENB using the superDimension version 7.1 (Medtronic, Plymouth, MN, USA) to target the lesion, radial endobronchial ultrasound was used as secondary confirmation. Next, transbronchial needle aspiration was performed prior to CBCT to evaluate placement of the biopsy tool in the lesion. The average nodule size was 21.7+/−15 mm with 59% (10/17) < 2 cm in all dimensions and 35% (6/17) showing a radiographic bronchus sign. The diagnostic yield of CBCT-guided ENB was 76% (13/17). No immediate periprocedural or postprocedural complications were identified. Our experience with CBCT-guided ENB further supports the comparable efficacy and safety of this procedure compared to other mature biopsy modalities. Studies designed to optimize the lung nodule biopsy process and to determine the contributions from different procedural aspects are warranted.

摘要

经支气管镜活检对肺部不明性质结节的诊断效果仍不理想。电磁导航支气管镜(ENB)结合锥形束 CT(CBCT)可提高诊断率。我们报告了 2021 年 4 月至 8 月期间,使用这种多模态方法对 14 例连续患者的 17 个肺部不明性质结节进行活检的经验。记录了患者的人口统计学信息、结节特征和活检结果。在配备西门子 Artis Q 双平面 CBCT(德国慕尼黑西门子公司)的杂交手术室中进行了这些操作。ENB 采用超维度 7.1 版(美敦力,明尼苏达州普利茅斯)引导靶向病变,然后使用径向支气管内超声作为二次确认。接下来,在 CBCT 前进行经支气管针吸活检,以评估活检工具在病变中的位置。平均结节大小为 21.7±15mm,所有维度的 59%(10/17)<2cm,35%(6/17)显示放射状支气管征。CBCT 引导下 ENB 的诊断率为 76%(13/17)。未发现即时围手术期或术后并发症。我们的 CBCT 引导下 ENB 经验进一步支持与其他成熟的活检方法相比,该程序具有相当的疗效和安全性。需要设计研究来优化肺结节活检过程,并确定不同操作方面的贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5da2/9412509/d591b1d1a3c9/tomography-08-00172-g001.jpg

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