Kriobiopsije perifernih plućnih nodusa kod različitih modaliteta navigacijske bronhoskopije

Nevenka Piskač Živković, Maja Karaman Ilić, Sunčana Divošević, Hrvoje Feljan, Igor Nikolić, Hrvoje Kaučić, Zrinka Juroš, Sven Seiwerth, Dragan Schwarz, Ivica Mažuranić

Uvod: Periferni plućni nodusi (PPNs) mogu biti radiološka manifestacija ranog stadija tumora pluća, a patohistološka dijagnoza preduvjet je početka liječenja. Postupci i metode: U radu su prikazani prvi rezultati kriobiopsije PPNs pomoću 1,1 fleksibilne kriosonde u Specijalnoj bolnici Radiochirurgia Zagreb, uz različite modalitete navigacijske bronhoskopije. Za PPNs intermedijarne zone plućnog parenhima korištena je kombinacija Virtual bronchoscopic navigation (VBN), Ultrathin bronchoscope (UTB) i Radial probe endobronchial ultrasound (RP-EBUS), a za PPNs vanjske trećine plućnog parenhima Electromagnetic navigational bronchoscopy with integrated digital tomosynthesis (DT-ENB). Rezultati: Dijagnoza PPNs potvrđena je patohistološkom analizom kod 37/42 bolesnika (88%). Svi bolesnici su imali pozitivan nalaz RP-EBUS neposredno prije uzimanja uzoraka za histološku analizu, neovisno o modalitetu navigacije ili karakteristikama nodusa. U pet bolesnika kod kojih nije potvrđena patohistološka dijagnoza, neovisno o modalitetu navigacije, negativan nalaz radijalnog ultrazvuka imala su četiri bolesnika (80%). Prema CTCAE komplikacije gradusa 2 zabilježene su kod 12%, a gradus 3 kod 2% bolesnika. Zaključak: Primjenom navigacijske bronhoskopije i kriobiopsije PPNs postignuta je visoka razina uspješne dijagnostike ranog stadija tumora pluća.

Introduction: Peripheral pulmonary nodules (PPNs) can be a radiological manifestation of earlystage lung cancer. Pathohistological diagnosis is required before treatment. Materials and methods: We present the first results of PPNs cryobiopsy using a 1.1 mm flexible cryoprobe at Special Hospital Radiochirurgia Zagreb, with different modalities of navigational bronchoscopy. For nodules in the intermediate zone of the lung parenchyma, a combination of virtual bronchoscopic navigation (VBN), ultrathin bronchoscope (UTB), and radial probe endobronchial ultrasound (RP-EBUS) was used. For nodules in the peripheral, outer third of the lung parenchyma,
electromagnetic navigational bronchoscopy with integrated digital tomosynthesis (DT-ENB) was employed.

Results: A pathohistological diagnosis of PPNs was confirmed in 37 of 42 patients (88 %). All had a positive RPEBUS finding immediately before sample collection for histological analysis, regardless of the navigation modality or nodule characteristics. Of the five patients in whom a histological diagnosis was not confirmed, four patients (80 %) had a negative radial ultrasound finding. According to CTCAE, grade 2 complications were recorded in 12 % of the patients, and grade 3 complications in 2 % of the patients.

Conclusion: A high level of successful diagnosis of early-stage lung cancer was achieved using navigational bronchoscopy and cryobiopsy for PPNs.