School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
Respir Med. 2022 Oct;202:106941. doi: 10.1016/j.rmed.2022.106941. Epub 2022 Aug 22.
Accurate biopsies of lung nodules, including small (<2 cm), bronchus sign negative lesions, remain challenging. Technological advances, however, may improve outcomes. We describe our experience using a novel system combining fluoroscopic navigation with digital tomosynthesis and continuous catheter tip tracking to guide lung nodule biopsies.
Demographic data, procedural characteristics, and biopsy results from prospectively enrolled patients were collected.
159 nodules (144 patients) were biopsied. Average nodule size was 22.2 ± 15.2 mm (axial), 21.7 ± 13.9 mm (coronal), and 33.2 ± 20.5 mm (sagittal), with 45% (n = 72) <2 cm in all dimensions and 66% (n = 105) without a bronchus sign. Diagnostic yield was 84% (134/159), with malignancy (n = 75, 47%) most common. A diagnosis was obtained in 75% (n = 54/72) of lesions that were <2 cm in all dimensions and 79% (n = 83/105) of bronchus sign negative lesions. Unadjusted generalized mixed-effects logistic regression models showed that nodule size as a categorical variable (>2 cm in any dimension) and as a continuous variable in the coronal dimension, the presence of a bronchus sign, and a concentric radial EBUS view had an increased odds ratio for diagnosis. A concentric radial EBUS view also had an increased OR for diagnosis in a fully adjusted mixed-effects logistic regression model.
Fluoroscopic navigation with digital tomosynthesis and continuous catheter tip tracking shows an overall improved diagnostic accuracy compared to historical controls, including for small, bronchus sign negative lesions. Future studies clarifying the optimal modality for patients with different nodules will be of importance to provide the most appropriate procedure tailored to each individual lesion's unique characteristics.
准确活检肺部结节，包括小(<2cm)、支气管征阴性病变，仍然具有挑战性。然而，技术进步可能会改善结果。我们描述了使用一种新系统的经验，该系统结合了透视导航与数字断层合成以及连续导管尖端跟踪，以指导肺部结节活检。
收集前瞻性入组患者的人口统计学数据、程序特征和活检结果。
共对 159 个结节（144 名患者）进行了活检。平均结节大小为 22.2±15.2mm（轴位）、21.7±13.9mm（冠状位）和 33.2±20.5mm（矢状位），45%（n=72）各维度均<2cm，66%（n=105）无支气管征。诊断率为 84%（134/159），最常见的是恶性肿瘤（n=75，47%）。<2cm 的所有维度的病变中，有 75%（n=54/72）和支气管征阴性病变中有 79%（n=83/105）获得诊断。未调整的广义混合效应逻辑回归模型显示，结节大小作为分类变量（任何维度均>2cm）和冠状位的连续变量、支气管征的存在以及同心径向 EBUS 视图均增加了诊断的优势比。在完全调整的混合效应逻辑回归模型中，同心径向 EBUS 视图也增加了诊断的优势比。
与历史对照相比，透视导航与数字断层合成和连续导管尖端跟踪显示出整体诊断准确性提高，包括对小、支气管征阴性病变。未来的研究阐明针对不同结节的最佳方式将很重要，以便为每个单独的结节的独特特征提供最合适的程序。
