Fernandez-Bussy Sebastian, Yu Lee-Mateus Alejandra, Barrios-Ruiz Alanna, Valdes-Camacho Sofia, Lin Katherine, Ibrahim Mohamed I, Vaca-Cartagena Bryan F, Funes-Ferrada Rodrigo, Reisenauer Janani, Robertson Kelly S, Hazelett Britney N, Chadha Ryan M, Abia-Trujillo David
Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.
Thorax. 2025 Feb 17;80(3):150-158. doi: 10.1136/thorax-2024-222502.
Sampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy (ssRAB) provides an alternative diagnostic procedure for this subtype of lesions.
A retrospective study on PPL attached to the peripheral pleura (PP), comprising costal and diaphragmatic pleura, mediastinal pleura (MP), and fissural pleura (FP) sampled by ssRAB, from January 2020 to December 2023. Clinicodemographic data, PPL characteristics and procedure-related details were recorded. Primary outcome was diagnostic yield, defined as all conclusive diagnoses, malignant or benign, over the total number of procedures. Secondary outcomes were safety profile, defined as the number of procedure-related complications, and diagnostic yield with the use of mobile cone-beam CT (mCBCT) and by biopsy tool.
182 nodules were sampled from 178 patients. PPLs were grouped as: PP (n=95), MP (n=30) and FP (n=57). Overall diagnostic yield was 80.2% (146/182) and sensitivity for malignancy was 83.2% (104/125). Diagnostic yield was associated with upper location (OR 2.86; 95% CI 1.35 to 6.03, p0.006), mCBCT (OR 2.27; 95% CI 1.06 to 4.86, p0.036) and cryobiopsy (OR 2.90; 95% CI 1.31 to 6.47, p0.009). Pneumothorax requiring chest tube was reported in five patients (2.8%), and a Nashville Scale grade 3 bleeding occurred in one patient (0.6%).
For pleural-based and fissure-based nodules, ssRAB showed a high diagnostic yield with low complications. The addition of mCBCT and cryobiopsy improved the diagnostic performance for this subtype of lesions.
对毗邻胸膜的周围型肺病变（PPL）进行采样时，发生气胸及并发症的风险较高。虽然通常采用影像引导下的经胸活检，但形状感知机器人辅助支气管镜检查（ssRAB）的出现为这类病变亚型提供了另一种诊断方法。
对2020年1月至2023年12月期间通过ssRAB采样的附着于外周胸膜（PP）的周围型肺病变进行回顾性研究，外周胸膜包括肋胸膜和膈胸膜、纵隔胸膜（MP）以及叶间胸膜（FP）。记录临床人口统计学数据、PPL特征及与操作相关的详细信息。主要结局为诊断率，定义为所有明确诊断（恶性或良性）占总操作数的比例。次要结局为安全性，定义为与操作相关的并发症数量，以及使用移动锥形束CT（mCBCT）和活检工具时的诊断率。
从178例患者中采样了182个结节。PPL分为：PP（n = 95）、MP（n = 30）和FP（n = 57）。总体诊断率为80.2%（146/182），恶性肿瘤的敏感性为83.2%（104/125）。诊断率与病变位于上叶（OR 2.86；95%CI 1.35至6.03，p<0.006）、mCBCT（OR 2.27；95%CI 1.06至4.86，p<0.036）及冷冻活检（OR 2.
