Elektromanyetik Navigasyon Diyagnostik Bronkoskopi (ENB)

Bilgisayar teknolojisindeki ilerlemeler, spiral toraks bilgisayarlı (BT) tomografisinden elde edilen verilerin kullanılarak, trakeobronşiyal ağacın sanal gerçeklikteki görüntülerinin oluşturulmasına imkan tanımaktadır. Periferik pulmoner lezyonlar yapılan görüntüleme tekniklerinde raslantısal olarak yaygın şekilde görülmektedir. Bu lezyonların giderek artan sıklıkta görülmesi, direk grafilerden üç kat daha duyarlı olan BT kullanımını artırmaktadır. Yeni bir bronkoskopik teknik olan elektromanyetik navigasyon diyagnostik bronkoskopi (ENB), periferal pulmoner lezyonlarda doğru tanı oranını artırmada gelecek vadeden bir yöntem olmaya başlamıştır. Bu lezyonların tanısında yaygın olarak kullanılan BT eşliğinde yapılan ince iğne aspirasyon biyopsisi (TTİAB), malign lezyonlarda %90 sensitiviteye sahipken %20 ila 30 oranında yanlış negatiflik oranına sahiptir. Ayrıca bu yöntem yaklaşık %25 oranında minör pnömotoraksa yol açmaktayken, %5 oranında göğüs tüpü drenajına gerek duyulmaktadır. Bronkoskopik tekniklerin, transtorasik biyopsiye göre ana avantajı daha üstün bir güvenliğe sahip olmasıdır. Elektromanyetik navigasyon diyagnostik bronkoskopi (ENB), ek floroskopik yöntem kullanmadan, özellikle inoperabl hastalarda erken tanı doğruluğunu artırmada faydalı olabilir.

Anahtar Kelimeler:

3-boyutlu spiral BT; endoskopik navigasyon, Elektromanyetik navigasyon

Electromagnetic Navigation Diagnostic Bronchoscopy (ENB)

Advances in computer technology have permitted development of virtual reality images of the tracheobronchial tree using data sets derived from helical CT of the chest. Peripheral pulmonary lesions (PPL) are common incidental findings. Their rising incidence has paralleled the increasing use of computed tomography (CT) as CT is approximately three times more sensitive than plain chest radiography (CXR) scans. Electromagnetic navigation bronchoscopy (ENB) is an exciting new bronchoscopic technique that promises accurate navigation to peripheral pulmonary target lesions. CT-guided transthoracic needle aspiration (TTNA) is a common method of obtaining tissue and whilst its pooled sensitivity for malignancy of %90 is impressive it also has a false negative rate of %20-30. Furthermore it is complicated by minor pneumothorax in approximately %25 of cases and major pneumothorax requiring a chest tube in %5 of cases. The main advantage of using bronchoscopic techniques rather than transthoracic biopsy is its superior safety profile. Electromagnetic navigation-guided bronchoscopy has the potential to improve the diagnostic yield of transbronchial biopsies without additional fluoroscopic guidance, and may be useful in the early diagnosis of lung cancer, particularly in nonoperable patients.

Keywords:

3-dimensional spiral CT; endoscopic guidance navigation, Electromagnetic navigation bronchoscopy,

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