Clinical application of cone beam CT guided technique in diagnosis of pulmonary nodules_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHI Dongchen ¹ ,  HUANG Haidong ¹ , WANG Qin ¹ , WANG Xiangqi ¹ , XIA Ying ¹ , LI Xiang ¹ , SHEN Xiaping ² , GAO Li ³ , YANG Yuguang ⁴ , DONG Yuchao ¹ ,  BAI Chong ¹

1. Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Medical University (The Second Military Medical University), Shanghai 200433, P. R. China;
2. Department of Radiology, Changhai Hospital, Naval Medical University (The Second Military Medical University), Shanghai 200433, P. R. China;
3. Department of Pathology, Changhai Hospital, Naval Medical University (The Second Military Medical University), Shanghai 200433, P. R. China;
4. Department of Anesthesiology, Changhai Hospital, Naval Medical University (The Second Military Medical University), Shanghai 200433, P. R. China;

Corresponding author：

HUANG Haidong, Email: hhdongbs@126.com; BAI Chong, Email: bc7878@sohu.com

Keywords：

Cone beam computed tomography; virtual bronchoscopic navigation; superimposed high frequency jet ventilator; bronchoscope; peripheral pulmonary nodules; biopsy; diagnosis

DOI：

10.7507/1671-6205.202210025

Video：

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Objective To explore the clinical application of the comprehensive guidance technologies, such as cone beam computed tomography (CBCT), virtual bronchoscopic navigation (VBN), and superimposed high-frequency jet ventilator for respiratory control in the biopsy of peripheral pulmonary nodules (PPNs). Methods The clinical information of 3 patients with PPNs diagnosed by CBCT combined with VBN and superimposed high frequency superposition jet ventilator in Shanghai Changhai Hospital were retrospectively analyzed. Results Clinical data of 3 patients were collected. The average diameter of PPNs was (25.3±0.3) mm with various locations in left and right lung. The first nodule was located in the apex of the left upper lung, and the biopsy was benign without malignant cells. The lesion was not enlarged during the 5-year follow-up. The second one was located in the left lingual lung, and the postoperative pathology was confirmed as mucosa-associated lymphoma. The third one was located in the anterior segment of the right upper lung. After the failure of endobronchial procedure, percutaneous PPNs biopsy under CBCT combined with VBN was performed, and the pathological diagnosis was confirmed as primary lung adenocarcinoma. Postoperative pneumothorax complication occurred in the third patient with right lung compression rate approximately 20%. Conclusions The application of CBCT, combined with VBN and the superimposed high frequency jet ventilator for respiratory control can potentially improve the accuracy and safety in the diagnosis of PPNs. Multi-center clinical trials are needed to verify its further clinical application.

Citation： SHI Dongchen, HUANG Haidong, WANG Qin, WANG Xiangqi, XIA Ying, LI Xiang, SHEN Xiaping, GAO Li, YANG Yuguang, DONG Yuchao, BAI Chong. Clinical application of cone beam CT guided technique in diagnosis of pulmonary nodules. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(10): 691-697. doi: 10.7507/1671-6205.202210025 Copy

1.	de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
2.	Ishiwata T, Gregor A, Inage T, et al. Advances in interventional diagnostic bronchoscopy for peripheral pulmonary lesions. Expert Rev Respir Med, 2019, 13(9): 885-897.
3.	Hohenforst-Schmidt W, Zarogoulidis P, Vogl T, et al. Cone beam computer tomography (CBCT) in interventional chest medicine - high feasibility for endobronchial realtime navigation. J Cancer, 2014, 5(3): 231-241.
4.	Heerink WJ, de Bock GH, de Jonge GJ, et al. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol, 2017, 27(1): 138-148.
5.	Taslakian B, Koneru V, Babb JS, et al. Transthoracic needle biopsy of pulmonary nodules: meteorological conditions and the risk of pneumothorax and chest tube placement. J Clin Med, 2019, 8(5): 727.
6.	Ost DE, Ernst A, Lei XD, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med, 2016, 193(1): 68-77.
7.	Khandhar SJ, Bowling MR, Flandes J, et al. Electromagnetic navigation bronchoscopy to access lung lesions in 1, 000 subjects: first results of the prospective, multicenter NAVIGATE study. BMC Pulm Med, 2017, 17(1): 59.
8.	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.
9.	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.
10.	Setser R, Chintalapani G, Bhadra K, et al. Cone beam CT imaging for bronchoscopy: a technical review. J Thorac Dis, 2020, 12(12): 7416-7428.
11.	Hohenforst-Schmidt W, Banckwitz R, Zarogoulidis P, et al. Radiation exposure of patients by cone beam CT during endobronchial navigation - A phantom study. J Cancer, 2014, 5(3): 192-202.
12.	Choi JW, Park CM, Goo JM, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol, 2012, 199(3): W322-W330.
13.	Verhoeven RLJ, van der Sterren W, Kong W, et al. Cone-beam CT and augmented fluoroscopy-guided navigation bronchoscopy: radiation exposure and diagnostic accuracy learning curves. J Bronchology Interv Pulmonol, 2021, 28(4): 262-271.
14.	Larke FJ, Kruger RL, Cagnon CH, et al. Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial. AJR Am J Roentgenol, 2011, 197(5): 1165-1169.
15.	Hur J, Lee HJ, Nam JE, et al. Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol, 2009, 192(3): 629-634.
16.	Choi SH, Chae EJ, Kim JE, et al. Percutaneous CT-guided aspiration and core biopsy of pulmonary nodules smaller than 1 cm: analysis of outcomes of 305 procedures from a tertiary referral center. AJR Am J Roentgenol, 2013, 201(5): 964-970.
17.	Mondoni M, Sotgiu G, Bonifazi M, et al. Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis. Eur Respir J, 2016, 48(1): 196-204.
18.	Lin CK, Fan HJ, Yao ZH, et al. Cone-beam computed tomography-derived augmented fluoroscopy improves the diagnostic yield of endobronchial uiltrasound-guided transbronchial biopsy for peripheral pulmonary lesions. Diagnostics (Basel), 2021, 12(1): 41.
19.	Ali EAA, Takizawa H, Kawakita N, et al. Transbronchial biopsy using an ultrathin bronchoscope guided by cone-beam computed tomography and virtual bronchoscopic navigation in the diagnosis of pulmonary nodules. Respiration, 2019, 98(4): 321-328.
20.	Kawakita N, Takizawa H, Toba H, et al. Cone-beam computed tomography versus computed tomography-guided ultrathin bronchoscopic diagnosis for peripheral pulmonary lesions: a propensity score-matched analysis. Respirology, 2021, 26(5): 477-484.
21.	Verhoeven RLJ, Fütterer JJ, Hoefsloot W, et al. Cone-beam CT image guidance with and without electromagnetic navigation bronchoscopy for biopsy of peripheral pulmonary lesions. J Bronchology Interv Pulmonol, 2021, 28(1): 60-69.
22.	Avasarala SK, Machuzak MS, Gildea TR. Multidimensional precision: hybrid mobile 2D/3D C-arm assisted biopsy of peripheral lung nodules. J Bronchology Interv Pulmonol, 2020, 27(2): 153-155.

1. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
2. Ishiwata T, Gregor A, Inage T, et al. Advances in interventional diagnostic bronchoscopy for peripheral pulmonary lesions. Expert Rev Respir Med, 2019, 13(9): 885-897.
3. Hohenforst-Schmidt W, Zarogoulidis P, Vogl T, et al. Cone beam computer tomography (CBCT) in interventional chest medicine - high feasibility for endobronchial realtime navigation. J Cancer, 2014, 5(3): 231-241.
4. Heerink WJ, de Bock GH, de Jonge GJ, et al. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol, 2017, 27(1): 138-148.
5. Taslakian B, Koneru V, Babb JS, et al. Transthoracic needle biopsy of pulmonary nodules: meteorological conditions and the risk of pneumothorax and chest tube placement. J Clin Med, 2019, 8(5): 727.
6. Ost DE, Ernst A, Lei XD, et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med, 2016, 193(1): 68-77.
7. Khandhar SJ, Bowling MR, Flandes J, et al. Electromagnetic navigation bronchoscopy to access lung lesions in 1, 000 subjects: first results of the prospective, multicenter NAVIGATE study. BMC Pulm Med, 2017, 17(1): 59.
8. 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.
9. 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.
10. Setser R, Chintalapani G, Bhadra K, et al. Cone beam CT imaging for bronchoscopy: a technical review. J Thorac Dis, 2020, 12(12): 7416-7428.
11. Hohenforst-Schmidt W, Banckwitz R, Zarogoulidis P, et al. Radiation exposure of patients by cone beam CT during endobronchial navigation - A phantom study. J Cancer, 2014, 5(3): 192-202.
12. Choi JW, Park CM, Goo JM, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol, 2012, 199(3): W322-W330.
13. Verhoeven RLJ, van der Sterren W, Kong W, et al. Cone-beam CT and augmented fluoroscopy-guided navigation bronchoscopy: radiation exposure and diagnostic accuracy learning curves. J Bronchology Interv Pulmonol, 2021, 28(4): 262-271.
14. Larke FJ, Kruger RL, Cagnon CH, et al. Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial. AJR Am J Roentgenol, 2011, 197(5): 1165-1169.
15. Hur J, Lee HJ, Nam JE, et al. Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol, 2009, 192(3): 629-634.
16. Choi SH, Chae EJ, Kim JE, et al. Percutaneous CT-guided aspiration and core biopsy of pulmonary nodules smaller than 1 cm: analysis of outcomes of 305 procedures from a tertiary referral center. AJR Am J Roentgenol, 2013, 201(5): 964-970.
17. Mondoni M, Sotgiu G, Bonifazi M, et al. Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis. Eur Respir J, 2016, 48(1): 196-204.
18. Lin CK, Fan HJ, Yao ZH, et al. Cone-beam computed tomography-derived augmented fluoroscopy improves the diagnostic yield of endobronchial uiltrasound-guided transbronchial biopsy for peripheral pulmonary lesions. Diagnostics (Basel), 2021, 12(1): 41.
19. Ali EAA, Takizawa H, Kawakita N, et al. Transbronchial biopsy using an ultrathin bronchoscope guided by cone-beam computed tomography and virtual bronchoscopic navigation in the diagnosis of pulmonary nodules. Respiration, 2019, 98(4): 321-328.
20. Kawakita N, Takizawa H, Toba H, et al. Cone-beam computed tomography versus computed tomography-guided ultrathin bronchoscopic diagnosis for peripheral pulmonary lesions: a propensity score-matched analysis. Respirology, 2021, 26(5): 477-484.
21. Verhoeven RLJ, Fütterer JJ, Hoefsloot W, et al. Cone-beam CT image guidance with and without electromagnetic navigation bronchoscopy for biopsy of peripheral pulmonary lesions. J Bronchology Interv Pulmonol, 2021, 28(1): 60-69.
22. Avasarala SK, Machuzak MS, Gildea TR. Multidimensional precision: hybrid mobile 2D/3D C-arm assisted biopsy of peripheral lung nodules. J Bronchology Interv Pulmonol, 2020, 27(2): 153-155.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical application of cone beam CT guided technique in diagnosis of pulmonary nodules

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