机器人辅助支气管镜诊断实性肺结节的有效性和安全性——一项多中心、前瞻性观察性研究。

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-10-01 DOI:10.1016/j.jtcvs.2025.05.021

Camilla Gomes MD, MS , Brandon Cowan MD , Mengqi Xiao MS, BS , Paul Morris MD , Damaris Pederson MPH , Kazuhiro Yasufuku MD, PhD

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引用次数: 0

摘要

目的：分析机器人辅助支气管镜（RAB）治疗包括半实性结节（SSN）和磨砂玻璃结节（GGN）在内的亚实性结节的有效性和安全性。方法：这是一项多中心前瞻性观察性研究的亚组分析，该研究调查了接受RAB治疗的亚实性结节患者。有效性的定义是通过支气管内径向超声（rEBUS）确认和活检前从支气管镜尖端到病变的中位距离来衡量，以及通过恶性肿瘤的敏感性和诊断率（DY）来衡量。收集不良事件以评估安全性。结果：679例患者中，91例（13.4%）为亚实性结节，其中SSN 78例，单纯GGN 13例。中位实下结节大小为18.5 mm， 61.5%位于肺上叶，89.0%位于肺外三分之二。恶性肿瘤发生率为45.1%，以腺癌为主。SSN的rEBUS定位率为81.4%，GGN的rEBUS定位率为61.5%，距支气管镜尖端的中位距离分别为22.0 mm和19.5 mm。SSN对恶性肿瘤的敏感性为77.8%，GGN为75.0%，而SSN对恶性肿瘤的敏感性为50.0%，GGN为61.5%。未诊断性结节31例（34.1%）。在实性结节组中，气胸发生率为4.4%，需要胸腔插管的气胸发生率为2.2%。在7天的随访期间，亚实性结节组未报告出血、呼吸并发症或死亡。结论：我们的研究结果证实RAB诊断实性结节是安全有效的。

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Diagnostic effectiveness and safety of robotic-assisted bronchoscopy for subsolid pulmonary nodules: A multicenter prospective observational study

Objective

To analyze the effectiveness and safety of robotic-assisted bronchoscopy (RAB) for subsolid nodules, including semisolid nodules (SSNs) and ground-glass nodules (GGNs).

Methods

This is a subset analysis of a multicenter, prospective observational study that investigated patients with subsolid nodules undergoing RAB. Effectiveness was defined by reach, measured by radial endobronchial ultrasound (rEBUS) confirmation and median distance from bronchoscope tip to the lesion prior to biopsy, and access, measured by sensitivity for malignancy and diagnostic yield (DY). Adverse events were recorded to assess safety.

Results

Of 679 patients analyzed, 91 (13.4%) had subsolid nodules, including 78 with SSNs and 13 with pure GGNs. The median subsolid nodule size was 18.5 mm, 61.5% were in the upper lobes, and 89.0% were in the outer two-thirds of the lung. The malignancy rate was 45.1%, predominantly adenocarcinoma. rEBUS localization rates were 81.4% for SSNs and 61.5% for GGNs, with median distance from the bronchoscope tip of 22.0 mm and 19.5 mm, respectively. Sensitivity for malignancy was 77.8% for SSNs and 75.0% for GGNs, while the strict DY was 50.0% and 61.5%, respectively. Nondiagnostic results occurred in 31 subsolid nodules (34.1%) at the index biopsy. The incidence of pneumothorax was 4.4% and that of pneumothorax necessitating a chest tube was 2.2% in the subsolid nodule cohort. No bleeding, respiratory complications, or mortalities were reported in the subsolid nodule cohort during the 7-day follow-up period.

Conclusions

Our findings confirm that RAB is safe and effective for diagnosing subsolid nodules.

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.