A novel technique for microwave ablation of malignant pulmonary nodules: electromagnetic navigation bronchoscopy with real-time digital subtraction angiography and computed tomography imaging guidance

Electromagnetic navigation bronchoscopy (ENB) has been used to guide the diagnosis and treatment of pulmonary nodules. However, its combined application with real-time digital subtraction angiography (DSA), computed tomography (CT), and microwave ablation (MWA) for malignant pulmonary nodules has not been documented. This study aimed to evaluate the feasibility and safety of a novel technique that integrates ENB with real-time two-dimensional (2D) and three-dimensional (3D) imaging guidance for MWA of malignant pulmonary nodules. Thirty-nine patients with 51 malignant pulmonary nodules underwent MWA using ENB with real-time DSA and cone-beam CT (CBCT). The 2D DSA were used to guide the positioning of the ablation probe in real-time, while 3D CBCT were performed before and after ablation to confirm the probe position and assess the ablation zone. The primary outcomes were technical success and complications. Secondary outcomes included navigation time, procedure time, radiation exposure, and ablation parameters. The ENB-guided MWA with real-time 2D and 3D imaging guidance was technically successful in 92.2% (47/51) nodules. The median navigation time was 12 min, and the median total procedure time was 85 min. The median total radiation dose from the CBCT scans was 276 mGy. No major complications occurred. Minor complications included haemoptysis (n = 2) and postoperative fever (n = 3) which resolved spontaneously. ENB combined with real-time 2D DSA guidance and 3D CBCT may be a feasible and safe technique for MWA of malignant pulmonary nodules.