Clinical utility of electromagnetic navigation bronchoscopy-guided microwave ablation in patients with inoperable high-risk pulmonary nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jie ¹ , ZHANG Yong ¹ , YE Maosong ¹ , LIU Zilong ¹ , HU Qin ² , ZHANG Xin ¹ ,  LI Chun ¹

1. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, P.R.China;
2. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P.R.China;

Corresponding?author：

LI Chun, Email: li.chun@zs-hospital.sh.cn

Keywords：

Electromagnetic navigation bronchoscopy; microwave ablation; pulmonary nodules; intervention treatment

DOI：

10.7507/1007-4848.202103027

Video：

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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.

Citation： LIU Jie, ZHANG Yong, YE Maosong, LIU Zilong, HU Qin, ZHANG Xin, LI Chun. Clinical utility of electromagnetic navigation bronchoscopy-guided microwave ablation in patients with inoperable high-risk pulmonary nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1315-1321. doi: 10.7507/1007-4848.202103027 Copy

1.	Oudkerk M, Liu S, MA Heuvelmans, et al. Lung cancer LDCT screening and mortality reduction—Evidence, pitfalls and future perspectives. Nat Rev Clin Oncol, 2021, 18(3): 135-151.
2.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3.	Folch EE, Labarca G, Ospina-Delgado D, et al. Sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: Systematic review and meta-analysis. Chest, 2020, 158(4): 1753-1769.
4.	Healey TT, March BT, Baird G, et al. Microwave ablation for lung neoplasms: A retrospective analysis of long-term results. JVIR, 2017, 28(2): 206-211.
5.	中華醫學會呼吸病學分會肺癌學組, 中國肺癌防治聯盟專家組. 肺結節診治中國專家共識(2018年版). 中華結核和呼吸雜志, 2018, 41(10): 763-771.
6.	Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
7.	Towe CW, Nead MA, Rickman OB, et al. Safety of electromagnetic navigation bronchoscopy in patients with COPD: Results from the NAVIGATE study. J Bronchology Interv Pulmonol, 2019, 26(1): 33-40.
8.	Yuan Z, Wang Y, Zhang J, et al. A meta-analysis of clinical outcomes after radiofrequency ablation and microwave ablation for lung cancer and pulmonary metastases. J Am Coll Radiol, 2019, 16(3): 302-314.
9.	Yang X, Ye X, Lin Z, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-Lung adenocarcinoma: A pilot study. J Cancer Res Ther, 2018, 14(4): 764-771.
10.	Gex G, Pralong JA, Combescure C, et al. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: A systematic review and meta-analysis. Respiration, 2014, 87(2): 165-176.
11.	Webb TN, Bonta DV, Masters R, et al. Jet ventilation decreases target motion and increases yield of ENB especially in lesions with negative bronchus sign. J Bronchology Interv Pulmonol, 2020, 27(1): 14-21.
12.	Wagh A, Ho E, Murgu S, et al. Improving diagnostic yield of navigational bronchoscopy for peripheral pulmonary lesions: A review of advancing technology. J Thorac Dis, 2020, 12(12): 7683-7690.
13.	Herth FJ, Eberhardt R, Sterman D, et al. Bronchoscopic transparenchymal nodule access (BTPNA): First in human trial of a novel procedure for sampling solitary pulmonary nodules. Thorax, 2015, 70(4): 326-332.
14.	Hogarth DK. Use of augmented fluoroscopic imaging during diagnostic bronchoscopy. Future Oncol, 2018, 14(22): 2247-2252.
15.	Cicenia J, Bhadra K, Sethi S, et al. Augmented fluoroscopy: A new and novel navigation platform for peripheral bronchoscopy. J Bronchology Interv Pulmonol, 2021, 28(2): 116-123.
16.	Pritchett MA, Schampaert S, de Groot JAH, et al. Cone-beam CT with augmented fluoroscopy combined with electromagnetic navigation bronchoscopy for biopsy of pulmonary nodules. J Bronchology Interv Pulmonol, 2018, 25(4): 274-282.
17.	Casal RF, Sarkiss M, Jones AK, et al. Cone beam computed tomography-guided thin/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: A prospective pilot study. J Thorac Dis, 2018, 10(12): 6950-6959.
18.	Chaddha U, Kovacs SP, Manley C, et al. Robot-assisted bronchoscopy for pulmonary lesion diagnosis: Results from the initial multicenter experience. BMC Pulm Med, 2019, 19(1): 243.
19.	Chen AC, Pastis NJ, Jr, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT). Chest, 2021, 159(2): 845-852.

1. Oudkerk M, Liu S, MA Heuvelmans, et al. Lung cancer LDCT screening and mortality reduction—Evidence, pitfalls and future perspectives. Nat Rev Clin Oncol, 2021, 18(3): 135-151.
2. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3. Folch EE, Labarca G, Ospina-Delgado D, et al. Sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: Systematic review and meta-analysis. Chest, 2020, 158(4): 1753-1769.
4. Healey TT, March BT, Baird G, et al. Microwave ablation for lung neoplasms: A retrospective analysis of long-term results. JVIR, 2017, 28(2): 206-211.
5. 中華醫學會呼吸病學分會肺癌學組, 中國肺癌防治聯盟專家組. 肺結節診治中國專家共識(2018年版). 中華結核和呼吸雜志, 2018, 41(10): 763-771.
6. Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
7. Towe CW, Nead MA, Rickman OB, et al. Safety of electromagnetic navigation bronchoscopy in patients with COPD: Results from the NAVIGATE study. J Bronchology Interv Pulmonol, 2019, 26(1): 33-40.
8. Yuan Z, Wang Y, Zhang J, et al. A meta-analysis of clinical outcomes after radiofrequency ablation and microwave ablation for lung cancer and pulmonary metastases. J Am Coll Radiol, 2019, 16(3): 302-314.
9. Yang X, Ye X, Lin Z, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-Lung adenocarcinoma: A pilot study. J Cancer Res Ther, 2018, 14(4): 764-771.
10. Gex G, Pralong JA, Combescure C, et al. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: A systematic review and meta-analysis. Respiration, 2014, 87(2): 165-176.
11. Webb TN, Bonta DV, Masters R, et al. Jet ventilation decreases target motion and increases yield of ENB especially in lesions with negative bronchus sign. J Bronchology Interv Pulmonol, 2020, 27(1): 14-21.
12. Wagh A, Ho E, Murgu S, et al. Improving diagnostic yield of navigational bronchoscopy for peripheral pulmonary lesions: A review of advancing technology. J Thorac Dis, 2020, 12(12): 7683-7690.
13. Herth FJ, Eberhardt R, Sterman D, et al. Bronchoscopic transparenchymal nodule access (BTPNA): First in human trial of a novel procedure for sampling solitary pulmonary nodules. Thorax, 2015, 70(4): 326-332.
14. Hogarth DK. Use of augmented fluoroscopic imaging during diagnostic bronchoscopy. Future Oncol, 2018, 14(22): 2247-2252.
15. Cicenia J, Bhadra K, Sethi S, et al. Augmented fluoroscopy: A new and novel navigation platform for peripheral bronchoscopy. J Bronchology Interv Pulmonol, 2021, 28(2): 116-123.
16. Pritchett MA, Schampaert S, de Groot JAH, et al. Cone-beam CT with augmented fluoroscopy combined with electromagnetic navigation bronchoscopy for biopsy of pulmonary nodules. J Bronchology Interv Pulmonol, 2018, 25(4): 274-282.
17. Casal RF, Sarkiss M, Jones AK, et al. Cone beam computed tomography-guided thin/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: A prospective pilot study. J Thorac Dis, 2018, 10(12): 6950-6959.
18. Chaddha U, Kovacs SP, Manley C, et al. Robot-assisted bronchoscopy for pulmonary lesion diagnosis: Results from the initial multicenter experience. BMC Pulm Med, 2019, 19(1): 243.
19. Chen AC, Pastis NJ, Jr, Mahajan AK, et al. Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT). Chest, 2021, 159(2): 845-852.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical utility of electromagnetic navigation bronchoscopy-guided microwave ablation in patients with inoperable high-risk pulmonary nodules

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