Chen Lun-Che, Yang Shun-Mao, Malwade Shwetambara, Chang Hao-Chun, Chang Ling-Kai, Chung Wen-Yuan, Ko Jen-Chung, Yu Chong-Jen
Interventional Pulmonology Center, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County 302, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu County 302, Taiwan.
Diagnostics (Basel). 2023 Mar 10;13(6):1055. doi: 10.3390/diagnostics13061055.
Lung cancer is the most lethal cancer type in Taiwan and worldwide. Early detection and treatment advancements have improved survival. However, small peripheral pulmonary nodules (PPN) biopsy is often challenging, relying solely on bronchoscopy with radial endobronchial ultrasound (EBUS). Augmented fluoroscopy overlays the intra-procedural cone-beam computed tomography (CBCT) images with fluoroscopy enabling real-time three-dimensional localization during bronchoscopic transbronchial biopsy. The hybrid operating room (HOR), equipped with various types of C-arm CBCT, is a perfect suite for PPN diagnosis and other interventional pulmonology. This study shares the single institute experience of EBUS transbronchial biopsy of PPN with the aid of augmented fluoroscopic bronchoscopy (AFB) and CBCT in an HOR. We retrospectively enrolled patients who underwent robotic CBCT, augmented fluoroscopy-guided, radial endobronchial ultrasound-confirmed transbronchial biopsy and cryobiopsy in a hybrid operating room. Patient demographic characteristics, computed tomography images, rapid on-site evaluation cytology, and final pathology reports were collected. Forty-one patients underwent transbronchial biopsy and 6 received additional percutaneous transthoracic core-needle biopsy during the same procedure. The overall diagnostic yield was 88%. The complications included three patients with pneumothorax after receiving subsequent CT-guided percutaneous transthoracic needle biopsy, and two patients with hemothorax who underwent transbronchial cryobiopsy. Overall, the bronchoscopic biopsy of PPN using AFB and CBCT as precise guidance in the hybrid operating room is feasible and can be performed safely with a high diagnostic yield.
肺癌是台湾及全球最致命的癌症类型。早期检测和治疗进展提高了生存率。然而，小的外周肺结节（PPN）活检往往具有挑战性，仅依靠带有径向支气管内超声（EBUS）的支气管镜检查。增强荧光透视将术中锥形束计算机断层扫描（CBCT）图像与荧光透视叠加，在支气管镜经支气管活检期间实现实时三维定位。配备各种类型C型臂CBCT的杂交手术室（HOR）是PPN诊断和其他介入肺病学的理想场所。本研究分享了在杂交手术室中借助增强荧光透视支气管镜检查（AFB）和CBCT对PPN进行EBUS经支气管活检的单机构经验。我们回顾性纳入了在杂交手术室接受机器人CBCT、增强荧光透视引导、径向支气管内超声确认的经支气管活检和冷冻活检的患者。收集了患者的人口统计学特征、计算机断层扫描图像、快速现场评估细胞学和最终病理报告。41例患者接受了经支气管活检，6例在同一手术过程中接受了额外的经皮经胸芯针活检。总体诊断率为88%。并发症包括3例在接受后续CT引导经皮经胸针活检后发生气胸的患者，以及2例接受经支气管冷冻活检后发生血胸的患者。总体而言，在杂交手术室中使用AFB和CBCT作为精确引导对PPN进行支气管活检是可行的，并且可以安全地进行，诊断率高。
