Electromagnetic Navigation

Improving outcomes in electromagnetic navigation bronchoscopy-guided transbronchial microwave ablation for pulmonary nodules: the role of cone-beam computed tomography

BACKGROUND

Studies have shown the potential of electromagnetic navigation bronchoscopy (ENB)-guided transbronchial microwave ablation (MWA) for treating pulmonary nodules. The role of cone-beam computed tomography (CBCT) in the procedure remains unknown.

OBJECTIVES

To investigate the efficacy and safety of employing CBCT during ENB-guided transbronchial MWA for pulmonary nodules.

DESIGN

Retrospective analysis of clinical records.

METHODS

Patients who underwent ENB-guided transbronchial MWA at the Department of Thoracic Surgery, Tongji Hospital. Patients were categorized into two groups: those who received CBCT during the procedure and those who did not. Technical and ablation success rates, complication rates, and patient characteristics were assessed.

RESULTS

A total of 283 patients with 371 nodules were included in the final analysis. The technical success rate was significantly higher in the CBCT group (97.0%) compared to the non-CBCT group (91.5%, p = 0.034). The overall ablation success rate was 88.1%, with the CBCT group demonstrating a higher rate (90.9% vs 81.5%, p = 0.018). Complication rates were similar between the two groups, with no significant differences.

CONCLUSION

The use of CBCT in ENB-guided transbronchial MWA significantly increases the technical and ablation success rates without raising complication rates. These findings underscore the potential advantages of CBCT in enhancing procedural outcomes for patients with pulmonary nodules. Further validation through larger, multi-center studies with longer follow-up is warranted.

H-marker via bronchoscopy under LungPro navigation combined with cone-beam computed tomography for locating multiple pulmonary ground-glass nodules: A case report and literature review

RATIONALE

Pulmonary ground-glass nodules (GGNs) pose challenges in intraoperative localization due to their primarily nonsolid composition. This report highlights a novel approach using H-marker deployment guided by LungPro navigation combined with cone-beam computed tomography (CBCT) for precise localization of multiple GGNs.

PATIENT CONCERNS

A 55-year-old female patient presented at Sir-Run-Run-Shaw Hospital, Zhejiang University School of Medicine, in June 2021, requiring thoracoscopic surgery for the management of multiple GGNs in her right lung. She had a recent history of thoracoscopic wedge resection for a lesion in her lower left lung 3 months prior.

DIAGNOSES

Computed tomography scans revealed the presence of 3 mixed GGNs in the right lung, with further confirmation identifying these as solitary pulmonary nodules, necessitating surgical intervention.

INTERVENTIONS

The patient underwent thoracoscopic surgery, during which the multiple nodules in her right lung were precisely localized utilizing an H-marker implanted bronchoscopically under the guidance of LungPro navigation technology, with CBCT providing additional confirmation of nodule positioning. This innovative combination of technologies facilitated accurate targeting of the lesions.

OUTCOMES

Postoperative histopathological analysis confirmed the nodules to be microinvasive adenocarcinomas. Radiographic examination with chest X-rays demonstrated satisfactory lung expansion, indicating effective lung function preservation following the procedure. Follow-up assessments have shown no evidence of tumor recurrence, suggesting successful treatment.

LESSONS

The employment of H-marker implantation guided by the LungPro navigation system with CBCT confirmation presents a feasible and efficacious strategy for localizing multiple pulmonary GGNs. To further validate its clinical utility and safety, large-scale, multicenter, prospective studies are warranted. This approach holds promise in enhancing the precision and outcomes of surgeries involving GGNs.

Efficiency of Electromagnetic Navigation Bronchoscopy and Virtual Bronchoscopic Navigation

BACKGROUND

Image-guided bronchoscopy techniques have emerged as a means of improving pulmonary nodule biopsy yield. However comparisons of the diagnostic efficacy of electromagnetic navigation bronchoscopy (ENB) and virtual bronchoscopic navigation (VBN) have not reached a consensus. This meta-analysis evaluates the overall diagnostic yield and accuracy of ENB and VBN for pulmonary nodules.

METHODS

A systematic search was conducted to identify relevant articles. Meta-analysis was used to summarize the sensitivities, specificities, and area under the curve for ENB and VBN.

RESULTS

Thirty-two studies (1981 patients with pulmonary nodules) were included in this analysis. The pooled sensitivity, specificity, and area under the curve (95% confidence interval) of ENB were 0.80 (0.73-0.85), 0.81 (0.71-0.88), and 0.87 (0.84-0.90), respectively. Corresponding VBN values were 0.80 (0.76-0.83), 0.65 (0.56-0.73), and 0.81 (0.78-0.85), respectively. Comparison of the 2 techniques revealed that ENB had higher specificity and area under the curve but no difference in sensitivity.

CONCLUSIONS

Both ENB and VBN are valuable tools in the diagnosis of lung nodules. ENB achieved a higher specificity than VBN in the diagnose of lung nodules, whereas ENB performed better than VBN for pulmonary nodules. These results are due to the real-time positioning function of ENB.

Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield

OBJECTIVES

To determine factors associated with diagnostic yield of ENB.

METHODS

In 112 consecutive patients referred to our department between March 2010 and December 2010 the diagnostic work-up for solitary pulmonary lesions included a FDG-PET-CT scan, and ENB in combination with ROSE. The final diagnosis was confirmed by histopathological evaluation of specimen obtained either by ENB, or - if ENB was not diagnostic - by CT-guided fine needle aspiration or surgery.

RESULTS

Thirty-seven (33%) subjects were female, mean age was 66.7 (±1.04) years. The mean diameter of lesions was 27mm (range: 6-46mm). In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis, as defined by the definite histopathological result. 15.2% (17/112) of lesions were benign, and 84.8% (95/112) were malignant. For 112 procedures we observed a steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively. The diagnostic yield in lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively. No significant difference in diagnostic yield was seen depending on lung function, and the localization of the lesions. Two cases (1.8%) of pneumothorax were seen during and up to 24h after bronchoscopy, none of them required a chest tube.

CONCLUSION

Diagnostic yield increased with experience but was independent from the size of the lesion, the localisation in the lungs, and lung function. The diagnostic yield of ENB can be as high as for CT-guided transthoracic biopsies but carries a significantly lower complication rate.

The pulmonologist's diagnostic and therapeutic interventions in lung cancer

Diagnostic and therapeutic strategies for lung cancer have improved with advancing technology and the acquisition of the necessary skills by bronchoscopists to fully use these advanced techniques. The diagnostic yield for lung cancer has significantly increased with the advent of technologies such as endobronchial ultrasound, navigational systems, and improved imaging modalities. Similarly, the therapeutic benefit of bronchoscopy in advanced lung cancer has begun to be understood for its impact on quality and quantity of life. This article highlights the pulmonologists' diagnostic advances and therapeutic options, with an emphasis on outcomes.