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BACKGROUND@#The incidence and mortality of lung cancer have always been at the forefront of malignant tumors. With the development of lung cancer detection techniques, more peripheral pulmonary lesions (PPLs) have been detected. The diagnostic accuracy of procedures for PPLs keeps controversial. This study aims to systematically evaluate the diagnostic value and the safety of electromagnetic navigation bronchoscopy (ENB) in the diagnosis of PPLs.@*METHODS@#The relevant literatures in the diagnostic yield of PPLs by ENB were systematically retrieved from Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, Embase, PubMed, Cochrane Library and Web of Science. The software of Stata 16.0, RevMan 5.4 and Meta-disc 1.4 were used to conduct the meta-analysis.@*RESULTS@#A total of 54 literatures with 55 studies were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ENB in the diagnosis of PPLs were 0.77 (95%CI: 0.73-0.81), 0.97 (95%CI: 0.93-0.99), 24.27 (95%CI: 10.21-57.67), 0.23 (95%CI: 0.19-0.28) and 104.19 (95%CI: 41.85-259.37), respectively. The area under curve (AUC) was 0.90 (95%CI: 0.87-0.92). Meta-regression and subgroup analyses indicated that the potential heterogeneity resulted from study type, additional localization techniques, sample size, lesion size and type of sedation. The use of additional localization techniques and general anesthesia have improved the diagnostic efficiency of ENB in PPLs. The incidence of adverse reactions and complications associated with ENB was very low.@*CONCLUSIONS@#ENB provides well diagnostic accuracy and safety.
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Humans , Bronchoscopy , Lung Neoplasms , Anesthesia , China , Electromagnetic PhenomenaABSTRACT
@#Objective To investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). Methods Patients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. Results Initially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.
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@#The coming out of electromagnetic navigation bronchoscopy gives exciting solution for diagnosis and even treatment of peripheral pulmonary nodules. It breaks the barriers of traditional bronchoscopy, and gives live visible imaging guidance for operators during biopsy of peripheral pulmonary nodules. The electromagnetic navigation bronchoscopy system can intelligently recognize and reconstruct the bronchial tree of the patients, and generate visible data and virtual guidance for the operators. It can perceive real-time magnetic localization of the signal, so as to precisely guide the navigational or biopsy tools. This review introduced the artificial intelligence configuration of the electromagnetic navigation bronchoscopy system based on the Veran system, and gave some improvement advices based on the defects of the system. In this way, we hope to promote the development and better clinical application of electromagnetic navigation bronchoscopy system.
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@#Objective To investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules. Methods The clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate. Results Pulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups. Conclusion Electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.
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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. .
Subject(s)
Humans , Bronchoscopy/methods , Electromagnetic Phenomena , Lung Neoplasms/surgery , Multiple Pulmonary Nodules/diagnosis , Thoracic SurgeryABSTRACT
@#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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Electromagnetic navigation bronchoscopy (ENB) is a novel type of bronchoscopy based on electromagnetic positioning technique combined with virtual bronchoscopy, three-dimensional computed tomography (CT) imaging and respiratory gating technique, which has been widely applied in clinic practice. In recent years, the domestic electromagnetic navigation system has also been developed rapidly, and its effectiveness and safety in the diagnosis, localization, and treatment of peripheral pulmonary lesions have been initially verified. In order to optimize and standardize the technical specifications of domestic ENB and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Respiratory Equipment Technology of Chinese Medical Equipment Association and the Expert Group on Technical of Domestic Electromagnetic Navigation Bronchoscopy. .
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The incidence of peripheral pulmonary lesions (PPLs) is growing following the adoption of lung cancer screening by low-dose chest CT. The diagnosis and treatment of pulmonary nodules is one of the most difficult problems. Based on the electromagnetic positioning technology, the electromagnetic navigation bronchoscope is guided to the pulmonary nodules for biopsy or treatment, providing a new minimally invasive diagnosis and treatment method for suspicious lung lesions. This paper provides an overview of the current status and progress of electromagnetic navigation bronchoscopy in the diagnosis and treatment of peripheral pulmonary diseases.
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BACKGROUND@#Electromagnetic navigation bronchoscopy is a tool that can accurately navigation peripheral lung lesions. Because of electromagnetic navigation bronchoscopy (ENB) is too expensive, it has not been widely used in China. It is urgent for us to summarize experience in clinical application, especially in the diagnosis of pulmonary nodules.@*METHODS@#The clinical data of patients with pulmonary peripheral lesions (PPLs) in our department undergoing ENB biopsy between July 2017 and December 2018 were retrospectively analyzed.@*RESULTS@#There were 18 patients with 21 PPLs (10 males and 8 females). Among them, 11 patients got the final pathological diagnosis, 8 cases were diagnosed with adenocarcinoma lung cancer, 1 case was diagnosed with tuberculosis and 2 cases were diagnosed with small cell lung cancer. The positive rate of diagnosis was 61.1%. The sensitivity was 73.3%. The positive diagnosis rate is related to the size of the lesion, the positive diagnosis rate for lesions >2 cm is 100.0% (P=0.04).@*CONCLUSIONS@#Electromagnetic navigation bronchoscope is safe and effective in clinic. It has a high positive rate for the diagnosis of peripheral lung lesions larger than 2 cm, ENB has broad clinical application prospects.
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BACKGROUND@#Electromagnetic navigation bronchoscopy (ENB) has become the latest minimally invasive diagnostic and therapeutic technique due to its characteristics, e.g., non-invasion, accuracy, real-time positioning. In this study, we investigated the application of ENB biopsy combined with Massage staining in the diagnosis and treatment of peripheral pulmonary lesions (PPL).@*METHODS@#The clinical data of 15 PPL patients undergoing ENB biopsy plus Massage staining between August 2017 and January 2018 were retrospectively reviewed. Among them, there were 12 male and 3 female, and the mean age was (51.3±2.1) years old.@*RESULTS@#The diameter of PPLs ranged from 6 mm to 36 mm (mean: 14.0 mm). The successful biopsy rate was 66.7%. All patients successfully underwent Massage staining. The distance between the centers of staining and lesion was (1.0±0.4) cm, and the diameter of staining was (2.8±0.6) cm. The mean operation time was (26.7±5.3 ) min, and the mean blood loss during surgery was (3.3±1.5) mL. There was no pneumothorax, hemothorax and pulmonary vascular injury during the procedure.@*CONCLUSIONS@#The ENB biopsy plus Massage staining technique caused very few complications, and provided high precision, which warrants further application.
Subject(s)
Female , Humans , Male , Middle Aged , Bronchoscopy , Methods , Electromagnetic Fields , Lung Diseases , Diagnosis , General Surgery , Lung Neoplasms , Diagnosis , General Surgery , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Staining and Labeling , MethodsABSTRACT
BACKGROUND@#More patients with pulmonary nodules are being referred to thoracic surgeons under the increasing use of computed tomography scans (CT). Impalpable peripheral subpleural solitary pulmonary nodules are difficult to be localized by video assisted thoracic surgery. Although some common techniques including CT-guided puncture positioning and electromagnetic navigation bronchoscopy (ENB)-guided methylene blue staining positioning, can bring good results in positioning, there are still some complications such as pneumothorax, hemorrhage and inaccurate positioning. Vectorial localization guided by electromagnetic navigational bronchoscopy followed by thoracoscopic resection is a novel alternative technique by us firstly for definitive diagnosis, which can avoid the possible injury of pleural or enlargement of the location area, providing some guidance for ENB-guided location technology. The main objective of this study was to evaluate the feasibility and our initial experience of vectorial localization guided by electromagnetic navigation followed by video-assisted thoracoscopic pulmonary solitary nodules resection.@*METHODS@#We retrospectively analyzed 22 cases who undergoing vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation prior to video assisted lung resection, and characteristics and intraoperative outcomes were explored.@*RESULTS@#Twenty-two nodules of twenty-two patients were all localized by this method successfully with an average location time (17.5±4.2) min. The average nodule size was (11.0±3.6) mm. The distance between the locatable guide probe (LG) and lesion on the electromagnetic navigation bronchoscopy screen was (14.5±10.1) mm. The distance between the lesion and probe mark on the dissected specimen was (15.3±11.0) mm. There was no displacement of any case. No conversion to thoracotomy was found. And there were no adverse events during the localization and operation procedure. Length of hospital stay was (3.8±1.2) d and the operative mortality was 0.0%. Malignant lesions were found in 19 patients and they were all completely resected with negative microscopic margins.@*CONCLUSIONS@#Our initial experience with vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation and minimally invasive resection proved that this technique was an alternative accurate and safe way for small pulmonary nodules. Thoracic surgeons should further investigate this method and apply it to clinical practice.
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With the advantages of real-time navigation and accurate positioning,electromagnetic navigation bronchoscopy has high clinical application value in biopsy of peripheral pulmonary diseases,biopsy of mediastinum and hilar lymph node lesions,and respiratory interventions requiring precise positioning of lung, airway and mediastinum. After more than ten years of clinical practice,this technique is considered to be safe,reliable,minimally invasive and highly efficient. The introduction and popularization of this technology in the field of pediatric respiratory diseases will promote the further development of interventional diagnosis and treatment of pediatric respiratory diseases.
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Despite therapeutic advances with minimally invasive surgical techniques, improved radiotherapy dosing with 3-dimensional planning, new chemotherapy agents and targeted therapies including epidermal growth factor receptor tyrosine kinase inhibitor, monoclonal antibody and anti-angiogenesis agents, the 5-year overall survival for lung cancer has remained relatively poor, mainly because by the time a diagnosis is made, lung cancer is often well advanced and treatment options are limited. The majority of lung cancer cases are diagnosed in a late stage, when nonspecific symptoms such as cough, dyspnea, and hemoptysis are present. Advances in early diagnostic and treatment options have the potential to manage lung cancer. The diagnostic approach to lung cancer may be divided into two problems; first, establishing the diagnosis and second, accuracy of staging. Bronchoscopy is now being used increasingly in the investigation and management of a wide spectrum of malignant, infectious, inflammatory, and other diseases or pathology of the lungs. There have been recently advances in bronchoscopic diagnosis of lung cancer; autofluorescence bronchoscopy, endobronchial ultrasound, and electromagnetic navigation bronchoscopy. Autofluorescene bronchoscopy exploits the inherent fluorescence property of cancerous tissue and improves detection of premalignant lesions not seen with white light bronchoscopy. Endobronchial ultrasound utilizes a flexible ultrasound probe to image and biopsy lesions and lymph nodes beyond the wall of the bronchus. Electromagnetic navigation bronchoscopy combines virtual bronchoscopy, three-demensional CT images, and a steerable probe to help navigate a bronchoscope to a particular peripheral lung lesion or lymph node. The purpose of this review is to describe current bronchoscopic advances in diagnosis and staging of lung cancer.