Translational lung cancer research · 2026
Electromagnetic navigation bronchoscopy-guided three-dimensional conformal microwave ablation for unresectable peripheral high-risk pulmonary nodules: a mid-term assessment with no real-time intraoperative CT/cone-beam computed tomography guidance.
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Liu Yawei, Huang Yan, Lin Xiaodan, Rong Yi, Mao Liurong, Lu Shijie, Chen Junying, Chen Jiyang, Xie Xiuying, Luo Kongjia
Аннотация
BACKGROUND: Radical resection is the gold standard for high-risk pulmonary nodules; however, many patients are not candidates for surgery or who decline surgery. Electromagnetic navigation bronchoscopy-guided three-dimensional conformal microwave ablation (ENB-DCMA) is a promising minimally invasive option. This study aimed to assess the mid-term safety and efficacy of a novel ENB-DCMA strategy which employs three-dimensional conformal planning to offset respiratory-induced lesion displacement.
METHODS: In this single-center retrospective study, we enrolled consecutive patients with peripheral high-risk pulmonary nodules who received ENB-DCMA owing to unsuitability for or refusal to surgery and radiotherapy between March 2021 and August 2023. The three-dimensional conformal strategy enlarged the ablative margin to compensate for respiratory-induced target motion exploratively, in the absence of real-time intraoperative computed tomography/cone-beam computed tomography (CT/CBCT) guidance. The primary efficacy endpoint was local progression-free survival (LPFS) post-ablation. Safety was evaluated according to the incidence of adverse events.
RESULTS: In total, 50 patients with 62 eligible pulmonary nodules were included, with 65 ablation procedures performed in total, including repeated ablation for three lesions. The technical success rate of this procedure was 95.2%. No procedure-related mortality was observed. The median follow-up was 37.1 (range, 14.7-59.9) months. The overall 3-year LPFS rate was 82.3%, and this rate reached 95.8% among patients with sub-solid nodules. The overall incidence of adverse events was 18.0% (9/50), including 12.0% (6/50) pneumothorax, 2.0% (1/50) postoperative fever, and 4.0% (2/50) self-limiting pulmonary hemorrhage; the rate of events requiring intervention was 4.0% (2/50).
CONCLUSIONS: ENB-DCMA serves as a safe and feasible minimally invasive therapeutic option for patients with high-risk pulmonary nodules. Further multicenter prospective trials are required to verify its long-term outcomes and broader clinical popularization value.
METHODS: In this single-center retrospective study, we enrolled consecutive patients with peripheral high-risk pulmonary nodules who received ENB-DCMA owing to unsuitability for or refusal to surgery and radiotherapy between March 2021 and August 2023. The three-dimensional conformal strategy enlarged the ablative margin to compensate for respiratory-induced target motion exploratively, in the absence of real-time intraoperative computed tomography/cone-beam computed tomography (CT/CBCT) guidance. The primary efficacy endpoint was local progression-free survival (LPFS) post-ablation. Safety was evaluated according to the incidence of adverse events.
RESULTS: In total, 50 patients with 62 eligible pulmonary nodules were included, with 65 ablation procedures performed in total, including repeated ablation for three lesions. The technical success rate of this procedure was 95.2%. No procedure-related mortality was observed. The median follow-up was 37.1 (range, 14.7-59.9) months. The overall 3-year LPFS rate was 82.3%, and this rate reached 95.8% among patients with sub-solid nodules. The overall incidence of adverse events was 18.0% (9/50), including 12.0% (6/50) pneumothorax, 2.0% (1/50) postoperative fever, and 4.0% (2/50) self-limiting pulmonary hemorrhage; the rate of events requiring intervention was 4.0% (2/50).
CONCLUSIONS: ENB-DCMA serves as a safe and feasible minimally invasive therapeutic option for patients with high-risk pulmonary nodules. Further multicenter prospective trials are required to verify its long-term outcomes and broader clinical popularization value.