Husta Bryan C, Menon Anu, Bergemann Reza, Lin I-Hsin, Schmitz Jaclyn, Rakočević Rastko, Nadig Tejaswi R, Adusumilli Prasad S, Beattie Jason A, Lee Robert P, Park Bernard J, Rocco Gaetano, Bott Matthew J, Chawla Mohit, Kalchiem-Dekel Or
Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
ERJ Open Res. 2024 Jul 22;10(4). doi: 10.1183/23120541.00993-2023. eCollection 2024 Jul.
This study aims to answer the question of whether adding mobile cone-beam computed tomography (mCBCT) imaging to shape-sensing robotic-assisted bronchoscopy (ssRAB) translates into a quantifiable improvement in the tool-lesion relationship.
Data from 102 peripheral lung lesions with ≥2 sequential mCBCT orbital spins and from 436 lesions with 0-1 spins were prospectively captured and retrospectively analysed. The primary outcome was the tool-lesion relationship status across the first and the last mCBCT spins. Secondary outcomes included 1) the change in distance between the tip of the sampling tool and the centre of the lesion between the first and the last spins and 2) the per-lesion diagnostic yield.
Compared to lesions requiring 0-1 spins, lesions requiring ≥2 spins were smaller and had unfavourable bronchus sign and intra-operative sonographic view. On the first spin, 54 lesions (53%) were designated as non-tool-in-lesion (non-TIL) while 48 lesions (47%) were designated as TIL. Of the 54 initially non-TIL cases, 49 (90%) were converted to TIL status by the last spin. Overall, on the last spin, 96 out of 102 lesions (94%) were defined as TIL and six out of 102 lesions (6%) were defined as non-TIL (p<0.0001). The mean distance between the tool and the centre of the lesion decreased from 10.4 to 6.6 mm between the first and last spins (p<0.0001). The overall diagnostic yield was 77%.
Targeting traditionally challenging lung lesions, intra-operative volumetric imaging allowed for the conversion of 90% of non-TIL status to TIL. Guidance with mCBCT resulted in a significant decrease in the distance between the tip of the needle to lesion centre.
本研究旨在回答将移动锥形束计算机断层扫描（mCBCT）成像添加到形状感知机器人辅助支气管镜检查（ssRAB）是否能在工具与病变关系方面带来可量化改善这一问题。
前瞻性收集并回顾性分析了102个有≥2次连续mCBCT眼眶旋转的周围性肺病变以及436个有0 - 1次旋转的病变的数据。主要结局是首次和末次mCBCT旋转时工具与病变关系的状态。次要结局包括：1）首次和末次旋转之间采样工具尖端与病变中心之间距离的变化；2）每个病变的诊断率。
与需要0 - 1次旋转的病变相比，需要≥2次旋转的病变更小，支气管征不佳且术中超声视野不理想。在首次旋转时，54个病变（53%）被判定为工具不在病变内（非TIL），而48个病变（47%）被判定为TIL。在最初的54例非TIL病例中，49例（90%）在末次旋转时转变为TIL状态。总体而言，在末次旋转时，102个病变中有96个（94%）被定义为TIL，102个病变中有6个（6%）被定义为非TIL（p<0.0001）。首次和末次旋转之间，工具与病变中心之间的平均距离从10.4毫米降至6.6毫米（p<0.0001）。总体诊断率为77%。
针对传统上具有挑战性的肺部病变，术中容积成像使90%的非TIL状态转变为TIL。mCBCT引导使针尖端与病变中心之间的距离显著缩短。
