Efficacy and safety of microwave ablation via different approaches for pulmonary nodules: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Hao , SHI Shenyun , LI Xinying , WANG Rujia , REN Lijun , DING Jingjing , XIAO Yonglong ,  YU Min

Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, P. R. China;

Corresponding author：

YU Min, Email: ymbig@126.com

Keywords：

Electromagnetic navigation bronchoscopy; microwave ablation; pulmonary nodules; efficacy; safety

DOI：

10.7507/1007-4848.202504033

Video：

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Objective To compare the efficacy and safety of computed tomography (CT)-guided percutaneous versus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) for the treatment of pulmonary nodules. Methods A retrospective analysis was conducted on the data of high-risk pulmonary nodule patients who underwent MWA at the Nanjing Drum Tower Hospital between 2022 and 2023. The pathological diagnosis rate, complications, and progression-free survival (PFS) were compared between the CT group and the ENB group. Results The CT group included 61 patients, while the ENB group comprised 53 patients. The pathological diagnosis rate in the CT group was slightly higher than that in the ENB group (88.52% vs. 71.69%, P=0.03). However, the ENB group exhibited a lower incidence of perioperative complications, including pneumothorax (16.39% vs. 3.77%, P=0.03), hemoptysis (19.67% vs. 5.66%, P=0.05), and pain (22.95% vs. 7.54%, P=0.03). There was no statistically significant difference in PFS between the two groups [HR=1.17, 95%CI (0.23, 5.81), P=0.85]. Conclusion Both CT-guided and ENB-guided MWA are effective treatment modalities for high-risk pulmonary nodules.

1.	郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2024, 46(3): 221-231.Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Chin J Oncol, 2024, 46(3): 221-231.
2.	Chan MV, Huo YR, Cao C, et al. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage I non-small cell lung cancer (NSCLC): a systematic review and meta-analysis. Eur Radiol, 2021, 31(7): 5421-5433.
3.	Folch EE, Labarca G, Ospina-Delgado D, et al. Sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: systematic review and meta-analysis. Chest, 2020, 158(4): 1753-1769.
4.	张晓菊, 白莉, 金发光, 等. 肺结节诊治中国专家共识(2018年版). 中华结核和呼吸杂志, 2018, 41(10): 763-771.Zhang XJ, Bai L, Jin FG, et al. Chinese expert consensus on diagnosis and treatment of pulmonary nodules (2018). Chin J Tuberc Respir Dis, 2018, 41(10): 763-771.
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6.	刘宝东, 陈海泉, 刘伦旭, 等. 肺结节多学科微创诊疗中国专家共识. 中国胸心血管外科临床杂志, 2023, 30(8): 1061-1074.Liu BD, Chen HQ, Liu LX, et al. Chinese expert consensus on multidisciplinary minimally invasive diagnosis and treatment of pulmonary nodules. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(8): 1061-1074.
7.	Yang X, Ye X, Lin Z, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-lung adenocarcinoma: a pilot study. J Cancer Res Ther, 2018, 14(4): 764-771.
8.	Tang EK, Chen CS, Wu CC, et al. Natural history of persistent pulmonary subsolid nodules: long-term observation of different interval growth. Heart Lung Circ, 2019, 28(11): 1747-1754.
9.	Wang N, Xue T, Zheng W, et al. Safety and efficacy of percutaneous biopsy and microwave ablation in patients with pulmonary nodules on antithrombotic therapy: a study with rivaroxaban bridging. Thorac Cancer, 2024, 15(28): 1989-1999.
10.	余敏, 石沈云, 李燕, 等. 电磁导航支气管镜联合支气管内径向超声引导肺活检诊断肺外周结节. 中国胸心血管外科临床杂志, 2022, 29(1): 44-49.Yu M, Shi SY, Li Y, et al. Diagnostic utility of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary lesions. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(1): 44-49.
11.	Kops SEP, Heus P, Korevaar DA, et al. Diagnostic yield and safety of navigation bronchoscopy: a systematic review and meta-analysis. Lung Cancer, 2023, 180: 107196.
12.	Chan JWY, Lau RWH, Ngai JCL, et al. Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance: a novel technique and initial experience with 30 cases. Transl Lung Cancer Res, 2021, 10(4): 1608-1622.
13.	Wang D, Li B, Bie Z, et al. Synchronous core-needle biopsy and microwave ablation for highly suspicious malignant pulmonary nodule via a coaxial cannula. J Cancer Res Ther, 2019, 15(7): 1484-1489.

1. 郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2024, 46(3): 221-231.Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Chin J Oncol, 2024, 46(3): 221-231.
2. Chan MV, Huo YR, Cao C, et al. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage I non-small cell lung cancer (NSCLC): a systematic review and meta-analysis. Eur Radiol, 2021, 31(7): 5421-5433.
3. Folch EE, Labarca G, Ospina-Delgado D, et al. Sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: systematic review and meta-analysis. Chest, 2020, 158(4): 1753-1769.
4. 张晓菊, 白莉, 金发光, 等. 肺结节诊治中国专家共识(2018年版). 中华结核和呼吸杂志, 2018, 41(10): 763-771.Zhang XJ, Bai L, Jin FG, et al. Chinese expert consensus on diagnosis and treatment of pulmonary nodules (2018). Chin J Tuberc Respir Dis, 2018, 41(10): 763-771.
5. 刘宝东, 支修益. 影像引导下热消融治疗肺部肿瘤的局部疗效评价. 中国医学前沿杂志(电子版), 2015, 7(2): 11-14.Liu BD, Zhi XY. Evaluation of local efficacy of image-guided thermal ablation for lung tumors. Chin J Med Front (Electron Ed), 2015, 7(2): 11-14.
6. 刘宝东, 陈海泉, 刘伦旭, 等. 肺结节多学科微创诊疗中国专家共识. 中国胸心血管外科临床杂志, 2023, 30(8): 1061-1074.Liu BD, Chen HQ, Liu LX, et al. Chinese expert consensus on multidisciplinary minimally invasive diagnosis and treatment of pulmonary nodules. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(8): 1061-1074.
7. Yang X, Ye X, Lin Z, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-lung adenocarcinoma: a pilot study. J Cancer Res Ther, 2018, 14(4): 764-771.
8. Tang EK, Chen CS, Wu CC, et al. Natural history of persistent pulmonary subsolid nodules: long-term observation of different interval growth. Heart Lung Circ, 2019, 28(11): 1747-1754.
9. Wang N, Xue T, Zheng W, et al. Safety and efficacy of percutaneous biopsy and microwave ablation in patients with pulmonary nodules on antithrombotic therapy: a study with rivaroxaban bridging. Thorac Cancer, 2024, 15(28): 1989-1999.
10. 余敏, 石沈云, 李燕, 等. 电磁导航支气管镜联合支气管内径向超声引导肺活检诊断肺外周结节. 中国胸心血管外科临床杂志, 2022, 29(1): 44-49.Yu M, Shi SY, Li Y, et al. Diagnostic utility of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary lesions. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(1): 44-49.
11. Kops SEP, Heus P, Korevaar DA, et al. Diagnostic yield and safety of navigation bronchoscopy: a systematic review and meta-analysis. Lung Cancer, 2023, 180: 107196.
12. Chan JWY, Lau RWH, Ngai JCL, et al. Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance: a novel technique and initial experience with 30 cases. Transl Lung Cancer Res, 2021, 10(4): 1608-1622.
13. Wang D, Li B, Bie Z, et al. Synchronous core-needle biopsy and microwave ablation for highly suspicious malignant pulmonary nodule via a coaxial cannula. J Cancer Res Ther, 2019, 15(7): 1484-1489.

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