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Endoscopic Technologies for Peripheral Pulmonary Lesions: From Diagnosis to Therapy. Life (Basel) 2023; 13:life13020254. [PMID: 36836612 PMCID: PMC9959751 DOI: 10.3390/life13020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Peripheral pulmonary lesions (PPLs) are frequent incidental findings in subjects when performing chest radiographs or chest computed tomography (CT) scans. When a PPL is identified, it is necessary to proceed with a risk stratification based on the patient profile and the characteristics found on chest CT. In order to proceed with a diagnostic procedure, the first-line examination is often a bronchoscopy with tissue sampling. Many guidance technologies have recently been developed to facilitate PPLs sampling. Through bronchoscopy, it is currently possible to ascertain the PPL's benign or malignant nature, delaying the therapy's second phase with radical, supportive, or palliative intent. In this review, we describe all the new tools available: from the innovation of bronchoscopic instrumentation (e.g., ultrathin bronchoscopy and robotic bronchoscopy) to the advances in navigation technology (e.g., radial-probe endobronchial ultrasound, virtual navigation, electromagnetic navigation, shape-sensing navigation, cone-beam computed tomography). In addition, we summarize all the PPLs ablation techniques currently under experimentation. Interventional pulmonology may be a discipline aiming at adopting increasingly innovative and disruptive technologies.
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Preoperative localization for lung nodules: a meta-analysis of bronchoscopic versus computed tomography guidance. Wideochir Inne Tech Maloinwazyjne 2022; 17:601-610. [PMID: 36818511 PMCID: PMC9909756 DOI: 10.5114/wiitm.2022.119586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Both computed tomography (CT)-guided and bronchoscopic localization strategies have been utilized prior to video-assisted thoracic surgery (VATS) as a means of achieving high lung nodule (LN) wedge resection success rates. Aim The present meta-analysis was thus developed for the assessment of the efficacy and safety of preoperative CT-guided and bronchoscopic LN localization approaches. Material and methods The PubMed, Cochrane Library, Embase, and Wanfang databases were searched for all relevant studies published through May 2022, with RevMan v5.3 being used to conduct pooled analyses of data pertaining to all endpoints of interest. Results In total, this meta-analysis incorporated data from 7 retrospective studies including 321 patients bearing 353 LNs that underwent CT-guided localization and 220 patients bearing 244 LNs that underwent bronchoscopic localization. When comparing the CT and bronchoscopic localization approaches, pooled rates of technical success (p = 0.20) and duration of localization (p = 0.20) were comparable. However, bronchoscopic localization was associated with significantly lower pooled rates of pneumothorax (p < 0.001) and pulmonary hemorrhage (p = 0.005) relative to CT-guided localization. In the CT group, the pooled VATS duration was significantly shorter compared with the bronchoscopic group (p = 0.04), although the pooled duration of postoperative hospitalization was comparable in both groups (p = 0.69). The heterogeneity was significant with respect to both the duration of localization (I2 = 97%) and the duration of postoperative hospitalization (I2 = 74%). Conclusions Relative to a CT-guided localization approach, the bronchoscopic localization of LNs can achieve similar clinical efficacy and superior safety.
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[Application and Progress of Electromagnetic Navigation Bronchoscopy in Department of Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:118-123. [PMID: 35224965 PMCID: PMC8913287 DOI: 10.3779/j.issn.1009-3419.2022.101.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Lung cancer ranks the first cancer-related morbidity and mortality in China. With the development and penetration of imaging technology, increasing small pulmonary peripheral Nodules (SPPNs) have been detected. However, precise location and diagnosis of SPPNs is still a tough problem for clinical diagnosis and treatment in department of thoracic surgery. With the development of electromagnetic navigation bronchoscopy (ENB), it provides a novel minimally invasive method for the diagnosis and treatment of SPPNs. In this review, we summarized the application and progress of ENB in preoperative positioning, diagnosis, and local treatment, then, discussed the clinical application of ENB in the hybrid operating room.
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Management of Ground-Glass Nodules: When and How to Operate? Cancers (Basel) 2022; 14:cancers14030715. [PMID: 35158981 PMCID: PMC8833330 DOI: 10.3390/cancers14030715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary An increasing number of lung cancer screening programs have detected the frequent occurrence of small pulmonary ground-glass nodules (GGNs). If GGN is an incidental finding, it should be followed according to the guidelines. A multidisciplinary team discussion should be initiated if a new solid component develops or the solid portion grows on follow-up CT. Preoperative attempts to biopsy solid components in part-solid GGNs are often not feasible and not helpful. If malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. Once the GGN is confirmed to be malignant, sub-lobar resection may be reasonable in the majority of cases, and the extent of lung resection should be determined based on the CT finding or intraoperative frozen section examination using special inflation technique. Although rare, the recurrence in the remaining lobe can occur especially in patients with high risk histologic features, which currently cannot accurately diagnosed either pre- or intra-operatively. Abstract With the increased popularity of low-dose computed tomography (LDCT), many patients present with pulmonary ground-glass nodules (GGNs), and the appropriate diagnostic and management strategy of those lesions make physicians be on the horn of the clinical dilemma. As there is not enough data available to set universally acceptable guidelines, the management of GGNs may be different. If GGN is an incidental finding through LDCT, the lesion should be followed according to the current guidelines. We recommend a multidisciplinary team discussion to be initiated if a new solid component develops or the solid portion size grows on follow-up CT as the risk of malignancy is high. Attempts to preoperatively biopsy solid components in part-solid GGNs are often not feasible and not helpful in clinical settings. Currently, if malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. If malignancy is confirmed, sub-lobar resection may provide an excellent oncologic outcome.
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Musgrove KA, Spear CR, Abbas K, Harris BR, Abbas G. Robotic pulmonary segmentectomy. J Thorac Dis 2021; 13:6179-6186. [PMID: 34795969 PMCID: PMC8575848 DOI: 10.21037/jtd.2019.12.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Kelsey A Musgrove
- Department of General Surgery, West Virginia University, Morgantown, WV, USA
| | - Charlotte R Spear
- Department of General Surgery, West Virginia University, Morgantown, WV, USA
| | - Kamil Abbas
- Department of General Surgery, West Virginia University, Morgantown, WV, USA
| | - Britney R Harris
- Department of General Surgery, West Virginia University, Morgantown, WV, USA
| | - Ghulam Abbas
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
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Xu R, Zhao M, Zhao Y, Xuan Y, Qin Y, Jiao W. Electromagnetic navigational bronchoscopy-guided dye marking to identify the subsegmental bronchus in thoracoscopic anatomic subsegmentectomy. Thorac Cancer 2021; 12:2819-2821. [PMID: 34405556 PMCID: PMC8520799 DOI: 10.1111/1759-7714.14116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 01/02/2023] Open
Abstract
Video‐assisted thoracoscopic surgery (VATS) subsegmentectomy has been widely used to resect small‐sized lung lesions in clinical practice. Precise identification of the subsegmental bronchus is one of the essential steps in performing thoracoscopic anatomic subsegmentectomy. Here, we report a thoracoscopic right S2a segmentectomy with preoperative electromagnetic navigational bronchoscopy (ENB)‐guided injection of methylene blue to identify the subsegmental bronchus in a 51‐year‐old male. We successfully performed complicated surgery using this method. This ENB‐guided dye marking method may accurately distinguish the subsegmental bronchus to effectively guide surgery.
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Affiliation(s)
- Rongjian Xu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min Zhao
- Center of Laboratory Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Yandong Zhao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunpeng Xuan
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Qin
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Song JW, Park IK, Bae SY, Na KJ, Park S, Kang CH, Kim YT. Electromagnetic Navigation Bronchoscopy-Guided Dye Marking for Localization of Pulmonary Nodules. Ann Thorac Surg 2021; 113:1663-1669. [PMID: 34052219 DOI: 10.1016/j.athoracsur.2021.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Electromagnetic navigation bronchoscopy (ENB)-guided dye marking is a useful localization modality for small pulmonary nodules. The purpose of this study was to evaluate the efficacy and safety of intraoperative full virtual ENB-guided dye marking. METHODS Patients who underwent full virtual ENB-guided dye marking without adjunct intraoperative imaging (fluoroscopy or cone beam computed tomography) for small pulmonary nodules were investigated retrospectively. Efficacy was evaluated on the basis of the success rates of dye marking (visible dye mark) and nodule localization, and safety was evaluated on the basis of the rate of ENB-related complications. RESULTS ENB-guided dye marking was performed on 164 nodules in 134 patients. Twenty-seven (20.1%) patients had multiple nodules. The total number of dye-marking attempts was 241, and the mean number of markings per nodule was 1.5±0.7. The mean ENB procedure duration was 30±15.1 min. No ENB-related complications were observed. The success rate of dye marking was 86.7% (209/241), and that of localization was 94.5% (155/164). Among 63 nodules with multiple dye-marking attempts, 62 (98.4%) were successfully localized. In 101 nodules with a single dye-marking attempt, 88 (87.1%) were localized with the visceral pleural dye mark. Additionally, 6 (5.9%) nodules could be localized with the needle hole on the visceral pleura. The number of dye-marking attempts was a significant factor in the success of localization (1.5±0.7 versus 1.1±0.3, p=0.01). CONCLUSIONS Full virtual ENB-guided dye marking was effective and safe for the localization of small pulmonary nodules. A multiple dye-marking strategy is recommended to achieve a high success rate.
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Affiliation(s)
- Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - So Young Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea; Seoul National University Cancer Research Institute, Seoul, South Korea
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Zhou C, Li X, Li W, Qian J. Clock dial integrated positioning combined with single utility port video-assisted thoracoscopic surgery: a new localization method for lung tumors. J Thorac Dis 2021; 13:1143-1150. [PMID: 33717587 PMCID: PMC7947540 DOI: 10.21037/jtd-20-3312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Preoperative localization of lung tumor mainly consisted of two methods: CT-guided percutaneous localization and electromagnetic navigation bronchoscopy-guided localization. However, these invasive methods could result in serious complications. In order to avoid the adverse effects of preoperative invasive localization, we propose a method of intraoperative noninvasive localization for lung tumors: clock dial integrated positioning (CDIP). Methods To retrospectively analyze the clinic data about the application of CDIP for 127 lung tumour patients in single utility port video-assisted thoracoscopic surgery (SUPVATS) between June 2017 and October 2017. Results One hundred and twenty-four cases (97.64%) underwent thoracoscopic surgery, which including 14 lobectomy, 107 partial resection, 2 lobectomy plus partial resection and 1 left pneumonectomy. Three cases (2.36%) underwent thoracoscopic biopsy. The mean operation time and intraoperative bleeding were 47.9±22.1 min and 70.1±40.3 mL, respectively. The mean postoperative hospital stay and chest drain duration were 3.9±2.2 and 3.6±1.8 days, respectively. There were 118 cases of malignant tumors, including adenocarcinoma (n=101), squamous cell carcinoma (n=9), large cell carcinoma (n=2), small cell lung carcinoma (n=3), and metastatic lung carcinoma (n=3). The remaining nine cases were benign tumors, including granuloma (n=3), intrapulmonary lymph node (n=2), sclerosing hemangioma (n=2), and hamartoma (n=2). The incidence of postoperative complications was 10.2%. There was no mortality, secondary operation, or conversion to open procedure due to massive intraoperative bleeding. Conclusions CDIP combined with SUPVATS is a safe, feasible, and effective method for the localization of lung tumors. This novel method can provide a reliable alternative technique when the marker is dislocated.
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Affiliation(s)
- Chao Zhou
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xinming Li
- Department of Cardiothoracic Surgery, Dehong People's Hospital, Affiliated Dehong People's Hospital of Kunming Medical University, Dehong, China
| | - Wentao Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Qian
- Department of Cardiothoracic Surgery, Dehong People's Hospital, Affiliated Dehong People's Hospital of Kunming Medical University, Dehong, China
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Yang YL, Li ZZ, Huang WC, Zhuang J, Lin DY, Zhong WZ, Lan B. Electromagnetic navigation bronchoscopic localization versus percutaneous CT-guided localization for thoracoscopic resection of small pulmonary nodules. Thorac Cancer 2021; 12:468-474. [PMID: 33398925 PMCID: PMC7882377 DOI: 10.1111/1759-7714.13775] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Identification of small pulmonary nodules is challenging in a limited intrathoracic field during minimally invasive video-assisted thoracoscopic surgery (VATS), and preoperative localization is required. Various techniques have been reported with some failure and complications. Here, we compare the feasibility and safety between electromagnetic navigation bronchoscopic marking and computed tomography (CT)-guided percutaneous marking using indocyanine green (ICG) and iopamidol. METHODS A total of 47 patients with small-sized pulmonary nodules, scheduled to undergo video-assisted thoracoscopic limited resection, were enrolled in this study. A mixture of diluted ICG and iopamidol was injected into the lung parenchyma as a marker, using CT-guided percutaneous or electromagnetic navigation bronchoscopic injection techniques and the results were examined and compared. RESULTS A total of 35 and 12 patients underwent preoperative marking by percutaneous injection and electromagnetic navigation bronchoscopic injection, respectively, in which a marker was detected in 33/35 (94.3%) and 12/12 (100%) patients. No combination of these procedures was performed in any patient. All markers were successfully detected in three patients who underwent injection marking at two different lesion sites. Pneumothorax occurred in five patients (14%) in the percutaneous marking group, which was relieved in all patients without the necessity for chest tube drainage. No other complication was observed in this study. CONCLUSIONS Electromagnetic navigation bronchoscopic injection techniques using indocyanine green fluorescence plus iopamidol are safe and effective, and comparable with CT-guided localization. Furthermore, a bronchoscopic approach enables marking of multiple lesion areas without increasing patient risk, especially for puncture-related pneumothorax. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Either computed tomography (CT)-guided percutaneous or electromagnetic navigation bronchoscopic injection techniques can be used for preoperative marking of pulmonary nodules with indocyanine green (ICG) fluorescence. WHAT THIS STUDY ADDS Indocyanine green (ICG) is a safe and easily detectable fluorescent marker for video-assisted thoracoscopic surgery (VATS). A bronchoscopic injection approach enables marking of multiple lesion areas without increasing the risk of pneumothorax.
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Affiliation(s)
| | - Zi-Zhe Li
- Shantou Central Hospital, Shantou, China
| | | | - Jia Zhuang
- Shantou Central Hospital, Shantou, China
| | | | - Wen-Zhao Zhong
- Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Lan
- Shantou Central Hospital, Shantou, China
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Piao Z, Han SJ, Cho HJ, Kang MW. Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules. J Thorac Dis 2020; 12:2467-2473. [PMID: 32642153 PMCID: PMC7330407 DOI: 10.21037/jtd.2020.03.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Recent advances in imaging modalities and recommended low-dose computed tomography screening programs have made it easier to diagnose early lung cancer. However, the diagnosis of small ground-glass nodules (GGNs) has been problematic due to inappropriate specimen procurement and failure of conventional percutaneous core needle biopsy. Thus, we aimed to evaluate the usefulness of electromagnetic navigation bronchoscopy (ENB)-guided video-assisted lung resection for not only the diagnosis but also treatment of GGNs. Methods From 2017 to 2019, 110 patients with suspicious lung cancer lesions that were not diagnosed by conventional procedure underwent ENB-guided lung resection. Among 35 cases of GGNs, 33 cases of localization were included in this study (two cup biopsy cases were excluded). We used SuperDimension™ for the ENB procedure. After general anesthesia, indigo carmine (0.3–0.5 mL) was injected, and GGNs were resected through video-assisted thoracoscopic surgery. Results Of the 33 GGNs, 16 were pure (2 adenocarcinomas in situ, 5 minimally invasive adenocarcinomas (MIAs), 3 adenocarcinomas, and 6 benign lesions) and 17 were mixed (1 MIA, 11 adenocarcinomas, and 5 benign lesions). The mean size of all lesions was 11.2±7.78 mm, mean distance to the pleura was 11.2±14.2 mm, and mean ENB procedure time was 18.8±8.88 minutes. Dye localization and surgical resection of GGN were successful in all cases. There was no procedure-related complication. Conclusions ENB is a feasible and highly accurate localization method for minimally invasive lung resection of small GGNs.
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Affiliation(s)
- Zhe Piao
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Joon Han
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Jin Cho
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Min-Woong Kang
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Cicenia J, Avasarala SK, Gildea TR. Navigational bronchoscopy: a guide through history, current use, and developing technology. J Thorac Dis 2020; 12:3263-3271. [PMID: 32642249 PMCID: PMC7330754 DOI: 10.21037/jtd-2019-ndt-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The peripheral pulmonary nodule offers unique challenges to the clinician, especially in regards to diagnostic approach. Quite often the etiology of the nodule is spurious, though the specter of malignancy drives accurate classification of the nodule. Diagnostic approaches range in degrees of invasiveness, accuracy, and morbidity. Bronchoscopic access to these nodules had been plagued by low reported yields, especially in fluoroscopically invisible nodules. Navigational bronchoscopy, however, allowed more accurate access to peripheral nodules while maintaining a low morbidity, and thus reshaped the historic diagnostic algorithms. Though navigational bronchoscopy was initially associated with electromagnetic navigation, newer approaches to navigation and new technologies provide enthusiasm that yield can improve. In this article we will provide a historical approach to navigational bronchoscopy, from its origins to its current state, and we will discuss developing technology and its potential role in the evolving paradigm of the peripheral nodule biopsy.
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Affiliation(s)
- Joseph Cicenia
- Division of Bronchoscopy, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sameer K Avasarala
- Division of Bronchoscopy, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas R Gildea
- Division of Bronchoscopy, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Yanagiya M, Kawahara T, Ueda K, Yoshida D, Yamaguchi H, Sato M. A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules. Eur J Cardiothorac Surg 2020; 58:40-50. [DOI: 10.1093/ejcts/ezaa050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 02/01/2023] Open
Abstract
Abstract
OBJECTIVES
Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking.
METHODS
The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking.
RESULTS
Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively.
CONCLUSIONS
This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.
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Affiliation(s)
- Masahiro Yanagiya
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiko Ueda
- Management Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Hirokazu Yamaguchi
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Abstract
With the advent of lung cancer screening, and the increasingly frequent use of computed tomography (CT) scanning for investigating non-pulmonary pathology (for example CT coronary angiogram), the number of pulmonary nodules requiring further investigation has risen significantly. Most of these nodules are found in the lung periphery, which presents challenges to biopsy, and many centers rely on trans-thoracic needle biopsy performed under image guidance by radiologists. However, the desire to minimize complications is driving the development of increasingly accurate navigation bronchoscopy platforms, something that will be crucial in the new era of bronchoscopic therapeutics for lung cancer. This review describes these platforms, summarizes the current evidence for their use, and takes a look at future developments.
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Affiliation(s)
- Samuel Victor Kemp
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom, .,National Heart and Lung Institute, Imperial College, London, United Kingdom,
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