锥形束计算机断层扫描引导的形状感知机器人支气管镜电磁导航支气管镜用于肺结节
Cone-beam computed tomography-guided shape-sensing robotic bronchoscopy electromagnetic navigation bronchoscopy for pulmonary nodules.
作者信息
Abdelghani Ramsy, Espinoza Diana, Uribe Juan P, Becnel David, Herr Rachel, Villalobos Regina, Kheir Fayez
机构信息
Division of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University Medical Center, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Internal Medicine, University of Miami, Miami, FL, USA.
出版信息
J Thorac Dis. 2024 Sep 30;16(9):5529-5538. doi: 10.21037/jtd-24-178. Epub 2024 Aug 28.
BACKGROUND
Electromagnetic navigation bronchoscopy (ENB) and shape-sensing robotic-assisted bronchoscopy (ssRAB) are minimally invasive technologies for the diagnosis of pulmonary nodules. Cone-beam computed tomography (CBCT) has shown to increase diagnostic yield by allowing real-time confirmation of position of lesion and biopsy tool. There is a lack of comparative studies of such platforms using CBCT guidance to overcome computed tomography to body divergence. The aim of this study was to compare the diagnostic yield of ENB- and ssRAB-guided CBCT for biopsy of pulmonary nodules.
METHODS
We conducted a retrospective comparative study of consecutive patients undergoing ENB-CBCT and ssRAB-CBCT. Navigational success was defined as biopsy tool within lesion confirmed during CBCT. Diagnostic yield was assessed using two methods: (I) presence of malignancy or benign histological findings that lead to a specific diagnosis at the time of bronchoscopy, and (II) longitudinal follow-up of patients with nonspecific benign finding during bronchoscopy.
RESULTS
ENB-CBCT was used to biopsy 97 nodules and ssRAB-CBCT was used to biopsy 111 nodules. Median size of the lesion for the ENB-CBCT group was 16.5 mm [interquartile range (IQR), 12-22 mm] as compared to 12 mm (IQR, 9-16 mm) in the ssRAB-CBCT group (P<0.001). Navigational success was 70.1% in ENB-CBCT arm as compared to 83% in ssRAB-CBCT arm respectively (P=0.03). Diagnostic yield was 66% for ENB-CBCT and 89.2% for ssRAB-CBCT (P<0.001) following bronchoscopy; 79.4% for ENB-CBCT and 95.4% for ssRAB-CBCT (P<0.001) with longitudinal follow-up data respectively. Following multivariate regression analysis adjusting for the size of the lesion, distance from the pleura, presence of bronchus sign, number of CBCT spins, and number of nodules, the odds ratio for the diagnostic yield was 4.72 [95% confidence interval (CI): 2.05-10.85; P<0.001] in the ssRAB-CBCT group as compared with ENB-CBCT. The overall rate of adverse events was similar in both groups (P=0.77).
CONCLUSIONS
ssRAB-CBCT showed increased navigational success and diagnostic yield as compared to ENB-CBCT for pulmonary nodule biopsies.
背景
电磁导航支气管镜检查（ENB）和形状感知机器人辅助支气管镜检查（ssRAB）是用于诊断肺结节的微创技术。锥形束计算机断层扫描（CBCT）已显示通过实时确认病变和活检工具的位置可提高诊断率。缺乏使用CBCT引导来克服计算机断层扫描与人体差异的此类平台的比较研究。本研究的目的是比较ENB引导和ssRAB引导的CBCT对肺结节活检的诊断率。
方法
我们对连续接受ENB-CBCT和ssRAB-CBCT的患者进行了一项回顾性比较研究。导航成功定义为在CBCT期间确认活检工具在病变内。使用两种方法评估诊断率：（I）在支气管镜检查时存在导致特定诊断的恶性或良性组织学结果，以及（II）对支气管镜检查时非特异性良性发现的患者进行纵向随访。
结果
ENB-CBCT用于97个结节的活检，ssRAB-CBCT用于111个结节的活检。ENB-CBCT组病变的中位大小为16.5毫米[四分位间距（IQR），12 - 22毫米]，而ssRAB-CBCT组为12毫米（IQR，9 - 16毫米）（P<0.001）。ENB-CBCT组的导航成功率为70.1%，而ssRAB-CBCT组为83%（P = 0.03）。支气管镜检查后，ENB-CBCT的诊断率为66%，ssRAB-CBCT为89.2%（P<0.001）；纵向随访数据显示，ENB-CBCT为79.4%，ssRAB-CBCT为95.4%（P<0.001）。在对病变大小、距胸膜距离、支气管征的存在、CBCT旋转次数和结节数量进行多变量回归分析调整后，与ENB-CBCT相比，ssRAB-CBCT组诊断率的优势比为4.72[95%置信区间（CI）：2.05 - 10.85；P<0.001]。两组的总体不良事件发生率相似（P = 0.
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