Endoskopie des peripheren Lungenrundherdes

Zusammenfassung

Lungenrundherde unklarer Dignität, häufig zufallsbefundlich entdeckt, stellen weiterhin eine diagnostische Herausforderung dar. Neben der operativen Resektion stehen die transthorakale Punktion und die Bronchoskopie mit transbronchialer Biopsie als minimal-invasive Verfahren zur Verfügung. Durch den Einsatz neuer Navigationstechniken lässt sich die Aussagekraft der Bronchoskopie zur Diagnostik von Lungenrundherden gegenüber der Röntgendurchleuchtung deutlich verbessern. Dabei ist ein Einsatz von endobronchialem Ultraschall, elektromagnetischer Navigation und virtueller Bronchoskopie auch ohne Röntgendurchleuchtung möglich und ihre Kombination steigert die Sensitivität. Diese Verfahren haben bereits einen festen Stellenwert bei Patienten mit einem unklaren peripheren Lungenbefund, bei denen aufgrund eines hohen operativen Risikos ein primärer chirurgischer Eingriff nicht möglich und bei denen eine Diagnose für die weitere Therapieplanung notwendig ist. Möglicherweise werden durch diese Techniken zukünftig aber auch erste endoskopische Therapieansätze möglich.

Abstract

Pulmonary nodules of unknown dignity, often incidental findings, still present a diagnostic challenge. Next to operative resection, we find minimal invasive therapies such as transthoracal punctions and bronchoscopy with transbronchial as further options. By using modern navigation techniques, the validity of bronchoscopy in diagnosing pulmonary nodules, compared to x-ray fluoroscopy, has already been improved. Thus, the use of endobronchial ultrasound, electromagnetic navigation and virtual bronchoscopy – even without x-ray fluoroscopy – is possible and the combination augments sensitivity. These techniques already rate high in patients with unclear peripheral pulmonary nodules and high risk profiles to surgical operations, thus not to be operated, but still in need of further diagnostic procedures in order to plan therapy options. A future use of endoscopic therapies may possibly be a first approach.

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