Enhancing Microwave Ablation for Lung Lesions with Cone-Beam Computed Tomography Guidance and Intrapulmonary Fine Adjustment in a Hybrid Operating Room.

RATIONALE AND

OBJECTIVES

To review outcomes of the first 150 consecutive microwave ablation (MWA) cases at our institution to assess the safety and diagnostic performance of a new workflow for cone-beam computed tomography (CBCT)-guided percutaneous MWA performed under general anesthesia in a hybrid operating room (HOR).

MATERIALS AND

METHODS

This retrospective study included 150 consecutive patients who underwent MWA in the CBCT-equipped HOR between July 2020 and January 2024. The procedural workflow involved general anesthesia with patient fixation, CBCT scanning, iGuide needle pathway planning, needle placement with a laser beam and augmented fluoroscopy guidance, and post-procedure ablation-zone assessment. Technical advancements included the use of a coaxial needle for synchronous biopsy and ablation and a fine adjustment tool.

RESULTS

In total, 145 lesions in 127 patients (82 women and 45 men; mean age, 59.8±13.1years [standard deviation]; single nodule, 113 patients; multiple nodules, 14 patients) were analyzed. The median global operating-room time, procedure time, total dose area product, and postoperative stay were 110 min, 45 min, 19,701 μGym², and 2 days, respectively. CBCT-guided MWA improved diagnostic yield for subcentimeter lung lesions to 50.0% with intra-parenchymal fine adjustment, compared to 10.1% without. Pneumothorax rates decreased significantly to 6% with coaxial needles for biopsy and ablation, compared to 12.1% with prior methods. Post-procedure complications were mostly tolerable, with two fatal complications occurring in the early cohort.

CONCLUSION

The MWA technique is safe and feasible, with various technical strategies enhancing its efficacy. The intra-parenchymal fine adjustment method significantly improves small-nodule biopsy yield.