Abstract：
Lung cancer is the most lethal cancer type in Taiwan and worldwide. Early detection and treatment advancements have improved survival. However, small peripheral pulmonary nodules (PPN) biopsy is often challenging, relying solely on bronchoscopy with radial endobronchial ultrasound (EBUS). Augmented fluoroscopy overlays the intra-procedural cone-beam computed tomography (CBCT) images with fluoroscopy enabling real-time three-dimensional localization during bronchoscopic transbronchial biopsy. The hybrid operating room (HOR), equipped with various types of C-arm CBCT, is a perfect suite for PPN diagnosis and other interventional pulmonology. This study shares the single institute experience of EBUS transbronchial biopsy of PPN with the aid of augmented fluoroscopic bronchoscopy (AFB) and CBCT in an HOR. We retrospectively enrolled patients who underwent robotic CBCT, augmented fluoroscopy-guided, radial endobronchial ultrasound-confirmed transbronchial biopsy and cryobiopsy in a hybrid operating room. Patient demographic characteristics, computed tomography images, rapid on-site evaluation cytology, and final pathology reports were collected. Forty-one patients underwent transbronchial biopsy and 6 received additional percutaneous transthoracic core-needle biopsy during the same procedure. The overall diagnostic yield was 88%. The complications included three patients with pneumothorax after receiving subsequent CT-guided percutaneous transthoracic needle biopsy, and two patients with hemothorax who underwent transbronchial cryobiopsy. Overall, the bronchoscopic biopsy of PPN using AFB and CBCT as precise guidance in the hybrid operating room is feasible and can be performed safely with a high diagnostic yield.
摘要：
肺癌是台湾和全世界最致命的癌症类型。早期检测和治疗进步提高了生存率。然而,周围小的肺结节（PPN）活检通常具有挑战性，仅依靠支气管镜和放射状支气管超声（EBUS）。增强荧光透视法覆盖了程序内锥形束计算机断层扫描（CBCT）图像，荧光透视法可以在支气管镜经支气管活检期间进行实时三维定位。混合手术室（HOR），配备各种类型的C臂CBCT，是PPN诊断和其他介入肺病学的完美套件。这项研究分享了借助增强荧光镜支气管镜（AFB）和CBCT在HOR中进行PPN的EBUS经支气管活检的单一机构经验。我们回顾性招募了接受机器人CBCT的患者，增强透视引导，在混合手术室中，经支气管超声证实的经支气管活检和冷冻活检。患者人口学特征,计算机断层扫描图像，快速现场评估细胞学，并收集最终病理报告。在同一过程中，有41例患者接受了经支气管活检，有6例接受了额外的经皮经胸芯针活检。总诊断率为88%。并发症包括3例患者在接受CT引导下经皮穿刺活检后出现气胸,和两名经经支气管冷冻活检的血胸患者。总的来说,在混合手术室中使用AFB和CBCT作为精确指导的PPN支气管镜活检是可行的,并且可以安全地以高诊断率进行.
