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Cryobiopsie endobronchique associée à la navigation électromagnétique peropératoire pour guider la résection chirurgicale des nodules pulmonaires périphériques de petite taille

par Taton, Olivier ;Bondue, Benjamin ;Sokolow, Youri ;Mekinda Ngono, Zita Lea ;Ruiz Patino, Maria Jose ;Vander Kuylem, M.;Remmelink, Myriam ;Leduc, Dimitri
Référence Revue médicale de Bruxelles, 40, 3, page (180-183)
Publication Publié, 2019-05-01

Article révisé par les pairs

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Résumé :

Introduction: An increasing number of pulmonary lesions of unknown etiology are detected as a result of systematic screening by HRCT (high resolution computed tomography) of high risk patients. The diagnosis of these early staged lesions is often difficult. Case report: A 68 year-old woman investigated for a hypereosinophilia showed at PET CT scan a 16 mm ground glass opacity with a mild FDG uptake in the left lower lobe. An electromagnetic navigation bronchoscopy was performed under general anesthesia in the operating room to reach the nodule and two trans-bronchial cryobiopsies were obtained. As an inconclusive pathological pattern was identified by rapid on site examination (ROSE), a coil was placed and methylene blue was injected into the target lesion in order to help the surgeon to find the tumour. During the video assisted thoracoscopy performed during the same general anesthesia, the marked zone was localized and a wedge resection was performed. The ROSE of the surgical specimen showed a lepidic adenocarcinoma forcing to perform a lobectomy of the left lower lobe with lymph node dissection. Finally, the diagnosis was a lepidic adenocarcinoma classified pt1bn0m0, staged IA2. Postoperative outcome of the patient was favorable. Discussion: The advantages of this technique are to perform the diagnosis and the treatment of an hypothetic lung cancer during the same anesthesia and to decrease the morbidity related to multiple interventions. Moreover, it may confirm the indication of the surgical resection. Conclusion: The intraoperative endoscopic procedure makes possible to confirm the surgical indication, while marking the lesion allows a limited surgical resection in a first step, particularly for nodules that are difficult to localize during surgery. In selected cases of lung nodules of unknown etiology, we propose to perform a cryobiopsy combined with electromagnetic navigation bronchoscopy to guide the surgical resection or eventually avoid surgery in benign pathology.