Shun-Mao Yang1,2, Wei-Chun Ko3, Ling-Hsuan Meng4, Li-Wei Chen2, Kun-Hsien Lin3, Yueh-Lun Liu3, Shao-En Sun3, Huan-Jang Ko1. 1. Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan. 2. Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan. 3. Department of Medical Imaging, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan. 4. Department of Advanced Therapy, Siemens Healthineers, Taipei, Taiwan.
Abstract
BACKGROUND: Bronchoscopic lung mapping is a multispot dye-marking technique, which should be performed under real-time fluoroscopic guidance and post-mapping computed tomographic reconstruction. This study aimed to investigate the feasibility of lung mapping followed by post-mapping computed tomography (CT) and additional needle localization in a cone bean CT (CBCT) room. METHODS: Between February 1, 2018 and August 31, 2018, 11 consecutive patients presenting with 14 lung lesions underwent bronchoscopic lung mapping in a CBCT room followed by thoracoscopic surgery. The efficacy and safety of the procedure were assessed through a retrospective chart review. RESULTS: The median size of the pulmonary lesions was 8.1 mm [interquartile range (IQR), 7.2-10.8 mm] with a median depth-to-size ratio (D-S) ratio of 2.43 (IQR, 1.56-2.79). Additional needle localizations were performed in 4 patients, of which 3 and 1 patients underwent dual localization with dye and microcoil and localization with dye only, respectively. The median total localization time was 28 min (IQR, 18-69 min), and the median radiation exposure was 345.0 mGy (IQR, 161.8-486.6 mGy). A total of 8 wedge resections, 5 segmentectomies, and 1 lobectomy were performed. The final pathological diagnoses were as follows: primary lung cancer (n=6), lung metastases (n=4), and benign lung lesions (n=4). No adverse events were observed, and the median length of postoperative stay was 4 days (IQR, 3-5 days). CONCLUSIONS: Bronchoscopic lung mapping followed by post-mapping CT and additional needle localization can be performed together in a single examination room equipped with a C-arm CBCT, and the results of localization are contributory to the surgery.
BACKGROUND: Bronchoscopic lung mapping is a multispot dye-marking technique, which should be performed under real-time fluoroscopic guidance and post-mapping computed tomographic reconstruction. This study aimed to investigate the feasibility of lung mapping followed by post-mapping computed tomography (CT) and additional needle localization in a cone bean CT (CBCT) room. METHODS: Between February 1, 2018 and August 31, 2018, 11 consecutive patients presenting with 14 lung lesions underwent bronchoscopic lung mapping in a CBCT room followed by thoracoscopic surgery. The efficacy and safety of the procedure were assessed through a retrospective chart review. RESULTS: The median size of the pulmonary lesions was 8.1 mm [interquartile range (IQR), 7.2-10.8 mm] with a median depth-to-size ratio (D-S) ratio of 2.43 (IQR, 1.56-2.79). Additional needle localizations were performed in 4 patients, of which 3 and 1 patients underwent dual localization with dye and microcoil and localization with dye only, respectively. The median total localization time was 28 min (IQR, 18-69 min), and the median radiation exposure was 345.0 mGy (IQR, 161.8-486.6 mGy). A total of 8 wedge resections, 5 segmentectomies, and 1 lobectomy were performed. The final pathological diagnoses were as follows: primary lung cancer (n=6), lung metastases (n=4), and benign lung lesions (n=4). No adverse events were observed, and the median length of postoperative stay was 4 days (IQR, 3-5 days). CONCLUSIONS: Bronchoscopic lung mapping followed by post-mapping CT and additional needle localization can be performed together in a single examination room equipped with a C-arm CBCT, and the results of localization are contributory to the surgery.
Authors: Xenia Fave; Dennis Mackin; Jinzhong Yang; Joy Zhang; David Fried; Peter Balter; David Followill; Daniel Gomez; A Kyle Jones; Francesco Stingo; Jonas Fontenot; Laurence Court Journal: Med Phys Date: 2015-12 Impact factor: 4.071