Background/Objectives: Computed tomography (CT)-guided transbronchial metallic coil marking is useful for identifying the locations of small peripheral pulmonary lesions. Even deeply located lesions may be accurately identified and resected with adequate margins. This method is also applicable to multiple lesions. The present study examined the efficacy of our marking method using cone-beam CT (CBCT) under general anesthesia in a hybrid operation room.Methods: In the hybrid operation room, an ultrathin bronchoscope was inserted into the objective bronchus under virtual bronchoscopic navigation, and a metallic coil was installed under CBCT guidance. The lesion was then resected with wedge resection by single- or 3-port video-assisted thoracoscopic surgery under fluorescence guidance. Eighty-seven patients with 90 lesions were treated between October 2016 and December 2022. The median lesion size was 11 mm and the median distance from the pleural surface was 8.7 mm. Lesions comprised 19 pure ground-glass nodule (GGN), 35 partly solid, and 36 solid types.Results: All lesions were visualized by CBCT, and metallic coils were installed into the objective bronchi. The median distance from lesions to coils was 3.6 mm, and the median marking time was 23.5 min. All lesions were resected with sufficient margins. In total, 57 lesions were diagnosed as primary lung cancer, 26 as metastatic lung tumors, 3 as nodular lymphoid hyperplasia, and 4 as others. There were no complications associated with the marking procedure.Conclusions: CBCT represents an alternative modality for identifying peripheral lung lesions due to its ability to visualize even small GGNs. It is a minimally invasive technique because the treatment sequence is completed under general anesthesia with the same quality as previous methods performed in a CT-equipped interventional radiology suite.
背景/目的：计算机断层扫描（CT）引导下经支气管金属线圈标记法有助于定位小型周围性肺部病灶。即使是位置较深的病灶，也能通过该方法准确定位并实现充分切缘切除。此技术同样适用于多发病灶。本研究旨在评估在混合手术室全身麻醉条件下，采用锥形束CT（CBCT）引导的标记方法的有效性。 方法：在混合手术室中，通过虚拟支气管镜导航将超细支气管镜置入目标支气管，并在CBCT引导下植入金属线圈。随后在荧光引导下，通过单孔或三孔电视辅助胸腔镜手术进行楔形切除。2016年10月至2022年12月期间，共对87例患者的90个病灶实施了该治疗。病灶中位大小为11毫米，距胸膜表面的中位距离为8.7毫米。病灶类型包括19个纯磨玻璃结节（GGN）、35个部分实性结节和36个实性结节。 结果：所有病灶均通过CBCT清晰显影，金属线圈成功植入目标支气管。病灶至线圈的中位距离为3.6毫米，中位标记时间为23.5分钟。所有病灶均实现充分切缘切除。病理诊断显示：57个病灶为原发性肺癌，26个为转移性肺肿瘤，3个为结节性淋巴组织增生，4个为其他类型。标记过程中未出现相关并发症。 结论：CBCT因其能够清晰显影包括小型磨玻璃结节在内的病灶，可作为定位周围性肺部病灶的替代成像方式。该技术具有微创特性，整个治疗流程在全身麻醉下完成，其操作质量与既往在配备CT的介入放射科实施的方法相当。
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