4D-Elektromagnetische Navigationsbronchoskopie zur Diagnostik peripherer Rundherde

Zusammenfassung

Hintergrund Die Abklärung peripherer Rundherde stellt eine besondere Herausforderung in der interventionellen Bronchologie dar, weswegen zunehmend Navigationssysteme wie die elektromagnetische Navigation (ENB) verwendet werden. Die 4D-ENB stellt eine innovative Weiterentwicklung der ENB dar. Durch In- und Exspirations-CT-Aufnahmen soll die atemabhängige CT-to-body-Divergenz überwunden und damit die Treffsicherheit peripherer Herde erhöht werden. Ziel dieser Arbeit ist eine Vorstellung des 4D-ENB-Verfahrens und die Präsentation erster klinischer Daten und Erfahrungen.

Methode Wir beschreiben retrospektiv die Resultate der ersten 9 konsekutiven Patienten mit PPN, die am Klinikum Braunschweig mittels 4D-ENB als unimodale Diagnostiktechnik untersucht wurden.

Resultate Von den ersten 9 mittels 4D-ENB untersuchten PPNs war eine erfolgreiche Navigation und Punktion des Herdes bei 8 Patienten (89%) möglich. Eine diagnostisch wegweisende Biopsie konnte bei 6 von 9 Patienten (67%) erreicht werden. Signifikante Komplikationen ergaben sich bei den Untersuchungen nicht.

Schlussfolgerung Unsere ersten Daten lassen die 4D-ENB als eine vielversprechende neue Alternative zur Abklärung von PPNs erscheinen. Um die diagnostische Ausbeute weiter zu verbessern, sollte die 4D-ENB aufgrund der fehlenden Echtzeitvisualisierung bevorzugt kombiniert mit radialem endobronchialem Ultraschall und/oder Fluoroskopie im Rahmen multimodaler Diagnostikkonzepte eingesetzt werden.

Abstract

Background The diagnostic of peripheral pulmonary nodules (PPN) is a particular challenge in interventional bronchology, which is why navigation systems such as electromagnetic navigation (ENB) are increasingly being used. The 4D-ENB represents the most current development of the ENB. It utilizes inspiratory and expiratory CT scans for mapping and thus helps compensate for respiratory movements-induced CT-to-body divergence. The aim of this work was to present the first clinical data and experiences using the 4D-ENB method for diagnosis of PPNs.

Methods We retrospectively describe the results of the first nine consecutive patient cases diagnosed at Klinikum Braunschweig using 4D-ENB in a unimodal diagnostic procedure.

Results Of the first 9 PPNs examined by 4D-ENB, navigation and puncture of the lesion was successful in 8 patients (89%). Diagnostic biopsy was could be carried out in six out of nine patients (67%). There were no significant procedure-related complications.

Conclusion Our preliminary data suggest that 4D-ENB is a promising new alternative for the diagnosis of PPNs. To further improve diagnostic yield, 4D-END, which lacks real-time visualization, should be embedded in a multimodal diagnostic procedure with rEBUS and/or fluoroscopy.

Schlüsselwörter

peripherer Rundherd - elektromagnetische Navigation - Bronchoskopie - 4D

Keywords

pulmonary nodules - electromagnetic navigation - bronchoscopy - 4D

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