Diagnosis and treatment of pulmonary nodules Example 2: Magnetic navigation-guided ablation of ground glass pulmonary nodules in patients with severe emphysema

It is urgent to establish norms and standards for minimally invasive treatment of pulmonary ground glass nodules.

Patient male, 70 years old. Smoking history. Physical examination showed that the ground-glass nodule in the upper right lung was 65438±0.6mm, which did not disappear after 3 months of follow-up. Pulmonary function showed severe obstructive ventilation dysfunction, which did not meet the surgical requirements.

The above picture shows the right upper lung 16mm ground glass nodule, which did not disappear after 3 months of follow-up. Under the background of severe emphysema, the nodule morphology conforms to the characteristics of early lung adenocarcinoma: clear boundary, curved blood vessels, lobulation and pleural traction. This form can undoubtedly be diagnosed by CT. Diagnosis does not require puncture.

The problem is that there is a 5 mm solid nodule below. Is it a transfer? Don't panic, the simple CT value is 800- 1000. It belongs to calcified nodules and can be completely ignored.

Ok, first of all, this ground-glass nodule cannot have lymph node metastasis and distant metastasis, and belongs to stage IA invasive adenocarcinoma (IAC). This is the basis of our local treatment. Surgical resection is the first choice for treatment, but the patient's lung function is poor and the operation risk is high.

For this patient, we chose the safe and effective microwave ablation under magnetic navigation bronchoscope.

Do a quick three-dimensional reconstruction first.

In the imaging software, we can rotate 360 degrees around the nodule and find that the bronchial cavity can reach the center of the ground glass nodule, which shows that the magnetic navigation catheter of bronchoscope can reach the center of the nodule and the position is satisfactory.

After full preparation, Medtronic magnetic navigation system was introduced, and the navigation path was made before operation.

After the anesthesiologist anesthetizes, the laryngeal mask airway is ventilated, and the bronchoscope begins to follow the preset path and navigation.

Localization of CT images in navigation and synchronous observation

Arrived smoothly.

Perspective positioning, the probe position is consistent with the previous CT image.

Replace the ultrasonic probe to further confirm the arrival of the nodule.

At the time of biopsy, the pathologist saw tumor cells under the field cytological microscope, which tended to adenocarcinoma.

Ablation was started immediately after diagnosis, and the time was 80w 15 minutes.

The operation time is about one hour. Patients can wake up immediately after operation, just like gastrointestinal endoscopy under general anesthesia. Without any side effects or adverse reactions.

The second day after operation, CT was reexamined, and the nodule position was coagulated and fibrosed, and the nodule area was covered by ablation, so it was possible to leave the hospital.

Nine months after operation, the nodules were absorbed more and denser than before. The CT value is greater than 100, and the lesion is confirmed as fibrotic tissue.

It can be seen that microwave ablation under magnetic navigation bronchoscope is a new method to treat early lung cancer. For patients with severe emphysema who cannot be operated, the treatment of ground glass nodules is an effective method with the least risk. The safety is very high, and there are basically no adverse reactions. However, at present, the requirements for hardware, software and operation skills of bronchoscopy room are still relatively high. Effective ablation requires preoperative CT diagnostic ability and preoperative path planning; It also needs the support and cooperation of anesthesiologists and pathologists to solve the diagnosis and treatment at one time. But at the same time, it is also possible that some patients need secondary ablation or CT-guided ablation to ensure complete ablation of pulmonary nodules.