Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance
Bronchoscopic Biopsy of Peripheral Lung Lesions Under Electromagnetic Guidance
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DOI：
10.1097/01.laboratory.0000147032.67754.22
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发表时间：
2005-01-01
影响因子：
3.3
通讯作者：
Schwarz, Yehuda
中科院分区：
文献类型：
--
作者：
Becker, Heinrich D.;Herth, Felix;Schwarz, Yehuda
背景：支气管镜检查是一种获得肺部病变活检的微创方法。如果没有获得活检，则需要更具侵入性的方法，如经胸针吸，电视辅助胸腔镜检查或诊断性开胸术，并且它们具有更大的并发症风险。此外，几乎一半的切除病变是良性的，在筛查项目中，这一比例可能超过90%。因此，必须权衡更多侵入性技术增加的并发症风险与发现良性病变的可能性。一种新的用于支气管镜检查的实时电磁引导系统在动物研究中获得肺活检方面取得了令人鼓舞的结果。目的：本研究的目的是确定这种新的引导系统在连续30例患有孤立外周肺病变的成人中获得活检的使用和安全性。干预措施：在数字化计算机断层扫描（CT）图像上标记解剖标志和靶病变，并存储，以便以后与引导系统配准的标志对齐。患者在磁导航板上，传感器探头通过肺部前进，并在显示先前采集的三维CT图像的监视器上实时跟踪。解剖标志与系统配准，然后系统自动创建导航方案以精确接近病变。到达病变后，确认与荧光镜检查和支气管内超声，活检obtained.Results：平均准确性的目标注册地标是在3毫米内的CT图像上给出的值。29名患者中有20名（69%）获得了结论性活检，25名患者的手术按计划进行。1例活检相关气胸和3例轻微自限性出血。结论：实时电磁引导支气管镜检查结合CT图像是一种可行且安全的方法，可用于获得周围性肺病变的活检。
Background: Bronchoscopy is a minimally invasive method for obtaining biopsies of lung lesions. If a biopsy is not obtained, more invasive methods such as transthoracic needle aspiration, video-assisted thoracoscopy, or diagnostic thoracotomy are required and they have a greater risk of complications. In addition, almost half of resected lesions are benign, and in screening programs, this proportion could be above 90%. Thus, the increased risk of complications from more invasive techniques must be weighed against the probability of finding benign lesions. A new, real-time electromagnetic guidance system for bronchoscopy has had promising results in obtaining lung biopsy in animal studies.Objective: The objective of this study was to determine the use and safety of this new guidance system in obtaining biopsies from 30 consecutive adults with isolated, peripheral lung lesions.Intervention: Anatomic landmarks and the target lesion were marked on digitized computed tomographic (CT) images and stored for later alignment with landmarks registered by the guidance system. With the patient on a magnetic navigation board, a sensor probe was advanced through the lungs and tracked in real-time on a monitor displaying the previously acquired, 3-dimensional CT images. Anatomic landmarks were registered with the system, which then automatically created a navigation scheme to approach the lesion precisely. After reaching the lesion, as confirmed with fluoroscopy and endobronchial ultrasound, biopsies were obtained.Results: Mean accuracy of target registration landmarks was within 3 mm of the values given on the CT images. Conclusive biopsies were obtained from 20 of 29 (69%) patients, and the procedure went as planned in 25. One biopsy-related pneumothorax and 3 cases of minor, self-limiting bleeding occurred. There were no serious complications.Conclusions: Real-time, electromagnetic-guided bronchoscopy, coupled with CT images, is a feasible and safe method for obtaining biopsies of peripheral lung lesions.