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@#Objective To explore the clinical utility and safety of electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) in the patients with inoperable high-risk pulmonary nodules. Methods Clinical data of patients who were diagnosed with inoperable pulmonary nodules highly suspected as malignant tumors and treated with ENB-guided MWA in Zhongshan Hospital, Fudan University from December 2019 to September 2020 were retrospectively collected and analyzed to evaluate the efficacy and safety of the procedure. There were 6 males and 3 females aged 72.0 (59.5-77.0) years. Results Totally ENB-guided MWA was performed in 9 patients with 12 lesions. All patients suffered from at least one chronic comorbidity. The inoperable reasons included poor pulmonary function (55.6%), comorbidities of other organs which made the surgery intolerable (33.3%), multiple lesions in different lobes or segments (22.2%), personal wills (22.2%) and advanced in age (11.1%). The median diameter of nodules was 13.5 (9.5-22.0) mm and the median distance from the edge of nodules to pleura was 5.3 (1.8-16.3) mm. Bronchoscope maneuver to the targeted lesions was manipulated according to navigation pathway under visual and X-ray guidance and confirmed with radial ultrasound probe. Rapid on-site evaluation also helped with primary pathological confirmation of biopsy specimen. Among all the lesions, 4 adenocarcinoma, 1 non-small cell lung cancer-not otherwise specified and 2 inflammatory lesions were reported in postoperative pathological diagnosis, while no malignant cells were found in 5 specimens. The ablation success rate was 83.3% (10/12). For the two off-targeted lesions, percutaneous ablations were performed as salvage treatment subsequently. The median hospitalization time was 3.0 (2.0-3.0) days and no short-term complications were reported in these patients. Conclusion ENB-guided MWA is a safe and effective procedure for patients with high-risk pulmonary nodules when thoracic surgery cannot be tolerated.
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Objective@#To evaluate the clinical application of bronchial washing fluid (BWF) in the detection of epidermal growth factor receptor (EGFR) gene mutation in lung cancer patients during diagnostic bronchoscopic procedure.@*Methods@#Patients with suspected lung cancer lesions but failed to be identified as malignancy by rapid on-site cytologic evaluation (ROSE) were enrolled. Performed blocker PCR for EGFR mutation detection using the supernatant and cell pellet of BWF samples and compared the detective results to the EGFR mutation status detected using histologic tumor samples.@*Results@#A total of 85 BWF and paired histological samples were collected at Fudan University Affiliated Zhongshan Hospital from October 2016 to June 2017. There were 46 male and 39 female, with a mean age of 61 years (range 30-87 years). Thirty-one patients had benign diseases and 54 patients had primary lung cancer. Among these 54 lung cancer patients, the diagnoses were made basing on bronchoscopic biopsy samples in 31 patients. The detection rate of EGFR gene mutation in BWF samples was 100.0% concordant with that using histological samples.Another 23 cases whose bronchoscopic biopsy failed to establish malignant diagnoses were further identified by other sampling methods including surgical resection, lung biopsy, etc. A total of 15 patients were identified as EGFR mutated type by pathologic detection or clinically effect assessment, and BWF could detect 11 of them, accounting for 11/15 of all cases. Overall, BWF had achieved an overall accuracy of 95.3% (81/85) comparing to paired tumor histologic samples.@*Conclusions@#BWF is an effective complementary specimen to bronchoscopic biopsy samples in EGFR gene mutation detection in patients with suspected lung cancer lesion and negative biopsy results evaluated by ROSE during bronchoscopy.
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Objective To evaluate the diagnostic value and safety of domestic electromagnetic navigation bronchoscopy (ENB) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions.Methods Sixty-four patients with peripheral pulmonary lesions shown by thoracic CT in Zhongshan Hospital,Fudan University between Jul.and Dec.,2014 were collected.The patients were randomly assigned to test group (underwent ENB in combination with X-ray guided TBLB) and control group (underwent X-ray guided TBLB).The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 24 months clinical follow-up.The operative time as well as the intraoperative and postoperative complications were also recorded.Results Sixty-four patients had 70 peripheral pulmonary lesions.There was no difference in age,sex,the lesion size or location between the two groups.Pathology results showed that the diagnostic yield of test group and control group were 88.6％ and 62.9％,respectively,with statistical significance (P =0.012).Subgroup analysis showed that if the lesion's diameter was ≤2 cm,the diagnosis yield of test group was higher than control group (66.7％ vs.20.0％,P =0.266);if the lesion was ＞2 and ≤3 cm,the diagnosis yield of test group and control group were 100 ％ and 81.8 ％,respectively (P =0.485).But if the lesion was＞3 cm,the diagnostic yield of the 2 group was significantly different (94.4 ％ in test group,63.1％ in control group,P =0.042).Mean operation duration of the 2 group was (966 ± 372)s and (1 040 ± 470) s,respectively,with no statistical difference (P =0.600).However,there was statistical difference between the 2 groups on the X-ray time needed to find the pulmonary lessions [(7.0 ± 4.8)s vs.(37.0 ± 37.5) s,P =0.008).There was no pneumothoraxes and excessive bleeding in patients undergoing ENB.Conclusions Compared with X-ray guide TBLB,ENB guided TBLB for peripheral pulmonary lesions has a certain degree of security,and has superiority in reducing the X-ray time required to find the lesion and improving diagnostic yield especially when the lesion's diameter was ＞3 cm.