Electromagnetic navigation bronchoscopy-guided microwave ablation safe in lung abnormality
Key takeaways:
- Researchers assessed three therapeutic methods for multiple bilateral ground-glass opacities.
- Electromagnetic navigation bronchoscopy-guided microwave ablation was a part of all three methods.
The safety of three therapeutic methods, each featuring electromagnetic navigation bronchoscopy-guided microwave ablation, was established in patients with multiple bilateral ground-glass opacities, according to study results.
“The results of our study demonstrate that this systematic hybrid technique ... is both safe and effective,” Siwei Wang, MD, PhD, of Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital, and colleagues wrote. “Furthermore, it even exhibits clear advantages over bilateral surgical procedure in certain cases.”
In a single-center, retrospective study published in Journal of Thoracic Disease, Wang and colleagues assessed 26 patients (50% men; mean age, 67.7 years) with multiple bilateral ground-glass opacities to determine if one of three therapeutic methods for this condition — simultaneous video-assisted thoracoscopic surgery (VATS) plus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (n = 5; 14 ground-glass opacities), VATS followed by ENB-guided microwave ablation (n = 8; 20 ground-glass opacities) and ENB-guided microwave ablation only (n = 13; 32 ground-glass opacities) — is best in terms of safety and efficacy.
Lung function, measured as FEV1/FVC ratio, was highest among those receiving simultaneous VATS plus ENB-guided microwave ablation (0.89), followed by those receiving VATS followed by ENB-guided microwave ablation (0.82) and those receiving only ENB-guided microwave ablation (0.75).
Researchers also observed that an Eastern Cooperative Oncology Group performance status of 1 or 2, signaling poorer performance, was found in more patients from the only ENB-guided microwave ablation group vs. the simultaneous group and the two-step group (nine patients vs. zero patients and three patients).
In terms of pure ground-glass opacities, the study noted 28 ground-glass opacities of this type out of 32 among those receiving only ENB-guided microwave ablation, which was a greater proportion than the ones found among those receiving simultaneous VATS and ENB-guided microwave ablation (seven out of 14) and those receiving two-step VATS and ENB-guided microwave ablation (nine out of 20).
Researchers reported better outcomes in the ENB-guided microwave ablation only group vs. the other groups when examining operation time, postoperative hospital stay and postoperative pain. In contrast, ablation time was significantly longer in these patients.
Variables that did not significantly differ between the three therapeutic methods included complications/adverse events, intraoperative pathology and non-detectable rates, according to the study.
A variable that did significantly differ was postoperative pathology, which included atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma and invasive adenocarcinoma.
“VATS combined with ENB-guided [microwave ablation] is safe and can also preserve as much pulmonary function as possible,” Wang and colleagues wrote.
“Large scale randomized studies are still needed to conduct further investigations into the efficacy and safety of different treatment procedures,” Wang and colleagues added.
Perspective
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One of the most significant current advances in the field of pulmonary medicine is the development and application of navigational systems using a patient’s thoracic imaging study (CT scan), coupled with either conventional bronchoscopy or robotic bronchoscopic platforms to aid pulmonologists in managing their patients.
As this technology improves, it continues to be employed for diagnosis of pulmonary nodules and other lung parenchymal abnormalities for which biopsy (sampling) is necessary in order to advance patient care. Beyond the diagnostic applications for navigational systems of bronchoscopy, however, are various potential therapeutic uses for this technology. In this paper by Wang and colleagues, this is exactly what is presented to us.
Specifically, these investigators deployed one of the navigational systems, electromagnetic navigation bronchoscopy, with a therapeutic intent. They address a relatively common clinical scenario of patients with multiple ground-glass opacities usually thought to represent a neoplastic process that resides on a spectrum of possibilities ranging from a benign or indolent low-level malignancy to a higher-grade invasive malignancy threatening patient survival.
The first step in evaluating patients with this condition is to establish a diagnosis, and navigational bronchoscopic systems are very useful for this purpose. However, even after a diagnosis is made, a clinical dilemma remains as how to best manage the condition, particularly when there are multiple, and often bilateral ground-glass opacities in the one patient. Treatment options in these cases may include surgery, radiation therapy, chemotherapy, immunotherapy or percutaneous image-directed ablation techniques. Among the newer emerging approaches, however, is bronchoscopic ablation therapies such as that reported by Wang and colleagues.
Their report, although retrospective in design and of a small number of patients in whom there was little long-term follow-up, does add useful information to the field in general. Further, it offers for our consideration a combined treatment or management approach coupling conventional thoracic surgical procedures with state-of-the-art navigational bronchoscopy for a commonly encountered condition in thoracic oncology. We will undoubtedly see further advancements in navigational bronchoscopy accompanied by various other therapeutic modalities and suggested management algorithms applied in service to patients with challenging presentations involving lung nodules.
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