Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, UPMC HIllman Cancer Center, Pittsburgh, PA.
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, UPMC HIllman Cancer Center, Pittsburgh, PA.
Surgery. 2023 May;173(5):1275-1280. doi: 10.1016/j.surg.2022.11.036. Epub 2023 Feb 14.
With the increasing use of computed tomography scans for lung cancer screening and surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. Electromagnetic navigational bronchoscopy-guided lung biopsy is a relatively new technique for bronchoscopic biopsy. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy-guided lung biopsy.
We conducted a retrospective review of patients who underwent an electromagnetic navigational bronchoscopy biopsy, performed by a thoracic surgical service, and evaluated its safety and diagnostic accuracy.
In total, 110 patients (men 46, women 64) underwent electromagnetic navigational bronchoscopy sampling of pulmonary lesions (n = 121; median size 27 mm; interquartile range 17-37 mm). There was no procedure-related mortality. Pneumothorax requiring pigtail drainage occurred in 4 patients (3.5%). Ninety-three (76.9%) of the lesions were malignant. Eighty-seven (71.9%) of the 121 lesions had an accurate diagnosis. Accuracy increased with increased lesion size (P = .0578) with a yield of 50% for lesions <2 cm, increasing to 81% for lesions ≥2 cm. The lesions that demonstrated a positive "bronchus sign" had a yield of 87% (45/52) compared with 61% (42/69) in lesions with a negative "bronchus sign" (P = .0359).
Thoracic surgeons can perform electromagnetic navigational bronchoscopy safely, with minimal morbidity and with good diagnostic yields. Accuracy increases with the presence of a bronchus sign and increasing lesion size. Patients with larger tumors and the bronchus sign may be candidates for this approach to biopsy. Further work is required to define the role of electromagnetic navigational bronchoscopy in the diagnosis of pulmonary lesions.
随着计算机断层扫描（CT）在肺癌筛查和其他癌症监测中的应用越来越多，胸外科医生开始为需要进行肺活检的患者转诊。电磁导航支气管镜引导下肺活检是一种相对较新的支气管镜活检技术。我们的目的是评估电磁导航支气管镜引导下肺活检的诊断效果和安全性。
我们对接受过电磁导航支气管镜活检的患者进行了回顾性分析，这些患者均由胸外科医生进行了评估，并对其安全性和诊断准确性进行了评估。
共有 110 名患者（男性 46 名，女性 64 名）接受了电磁导航支气管镜对肺部病变的采样（n=121；病变中位大小 27mm；四分位间距 17-37mm）。无与操作相关的死亡病例。4 例（3.5%）患者发生需要引流的气胸。93 例（76.9%）病变为恶性。121 个病变中有 87 个（71.9%）得到了准确诊断。随着病变大小的增加，诊断的准确性也随之增加（P=0.0578），病变<2cm 的诊断率为 50%，病变≥2cm 的诊断率增加到 81%。有阳性“支气管征”的病变诊断率为 87%（45/52），而无阳性“支气管征”的病变诊断率为 61%（42/69）（P=0.0359）。
胸外科医生可以安全地进行电磁导航支气管镜检查，其发病率低，诊断效果好。准确性随着支气管征的出现和病变大小的增加而增加。有较大肿瘤和支气管征的患者可能是该活检方法的候选者。还需要进一步的工作来确定电磁导航支气管镜在肺部病变诊断中的作用。
