Eur J Cardiothorac Surg. 2023 Jan 6:ezad006. doi: 10.1093/ejcts/ezad006. Online ahead of print.
ABSTRACT
OBJECTIVES: We developed a novel wireless localization technique after electromagnetic navigation bronchoscopy-guided radiofrequency identification marker placement for fluoroscopically invisible small lung lesions. We conducted an observational study to investigate the feasibility of this technique and retrospectively compared 2 marking approaches with or without cone-beam computed tomography.
METHODS: Consecutive patients from January 2021 to March 2022 in our institution were enrolled. Markers were placed central to the lesions either in a bronchoscopic suite under intravenous anaesthesia or a hybrid operation theater with cone-beam computed tomography under general anaesthesia. The efficacy of the two marking methods was compared using an inverse probability of treatment weighting adjusted analysis.
RESULTS: Totally 80 markers were placed (45 under cone-beam computed tomography and 35 under fluoroscopy) for 74 patients with 80 lesions ((mean size: 6.9 mm (interquartile range: 5.1-8.4) at a median depth from the pleura of 14.0 mm (interquartile range: 8.5-19.5)). The median distance from marker to lesion was 9.1 mm, with a pleural depth of 15.5 mm. The tumour resection rate was 97.5% (78/80) with the median surgical margin of 10.0 mm (interquartile range: 8.0-11.0). Although the bronchoscopy time was longer using cone-beam computed tomography because of the need for 2.8 scans per lesion, the distance from the marker to the lesion was shorter for marking using cone-beam computed tomography than marking using fluoroscopy (adjusted difference: -4.56, 95% CI: -6.51 to -2.61, p < 0.001).
CONCLUSIONS: Electromagnetic navigation bronchoscopy-guided radiofrequency identification marking provided a high tumour resection rate with sufficient surgical margins.
PMID:36617166 | DOI:10.1093/ejcts/ezad006
