Three-dimensionally printed navigational template: a promising guiding approach for lung biopsy

Abstract

Background: Percutaneous transthoracic lung biopsy is customarily conducted under computed tomography (CT) guidance, which primarily depends on the conductors' experience and inevitably contributes to long procedural duration and radiation exposure. Novel technique facilitating lung biopsy is currently demanded. Methods:Based on the reconstructed anatomical information of CT scans, a three-dimensionally printed navigational template was customized to guide fine-needle aspiration (FNA). The needle insertion site and angle could be indicated by the template after proper placement according to the reference landmarks. From June 2020 to August 2020, patients with peripheral indeterminate lung lesions ≥30 mm in diameter were enrolled in a pilot trial. Cases were considered successful when the virtual line indicated by the template in the first CT scan was pointing at the target, and the rate of success was recorded. The insertion deviation, procedural duration, radiation exposure, biopsy-related complications, and diagnostic yield were documented as well.Results: A total of 20 patients consented to participate, and 2 withdrew. The remaining 18 participants consisting of 11 men and 7 women with a median age of 63 [inter-quartile range (IQR), 50-68] years and a median body mass index (BMI) of 23.5 (IQR,) kg/m 2 received template-guided FNA. The median nodule size of the patients was 41.2 (IQR, 36.2-51.9) mm and 17 lesions were successfully targeted (success rate, 94.4%). One lesion was not reached through the designed trajectory due to an unpredictable alteration of the lesion's location resulting from pleural effusion. The median deviation between the actual position ^ ORCID: Haoran E, 0000-0002-9160-7646; Chang Chen, 0000-0002-9981-3110. of the needle tip and the designed route was 9.4 (IQR, 6.8-11.7) mm. The median procedural duration was 10.7 (IQR, 9.7-11.8) min, and the median radiation exposure was 220.9 (IQR,) mGy×cm. No major biopsy-related complication was encountered. Definitive diagnosis of malignancy was reached in 13 of the 17 (76.5%) participants. Conclusions:The feasibility and safety of navigational template-guided FNA were preliminarily validated in lung biopsy cohort. Nonetheless, patients with pleural effusion were not recommended to undergo FNA guided by such technique.

Application of three-dimensional technology in video-assisted thoracoscopic surgery sublobectomy

“…Second, the cost of 3D printing might be prohibitive for many patients. However, if one opts to 3D print only the physical navigation templates rather than the entire lung model, the cost is considerably reduced, averaging between $75-90 (9).The high cost of 3D printing technology impacts not just patients but also hospitals, encompassing expenses related to the purchase and maintenance of 3D printers, material costs for the models, and other factors that hinder its broad adoption. 3D and are timeconsuming processes; designing and printing a basic 3D physical navigation template can take between three to five hours (10).…”

“…2022, E H, et al(9), 2017, Zhang L, et al(10), 2020, Fu R, et al (11), 2019, Zhang L, et al (12) navigational template; preoperative nodule localization Feasible, safe, accurate, and fast 2019, Kitano K, et al (13), 2018, Sato M, et al (14). 2021, Zhao L, et al (17) dial positioning method; intraoperative nodule localization This method is accurate, safe, fast, without radiation exposure 2019, Sun W, et al (18) navigation template; intraoperative nodule localization; multiple pulmonary nodules.…”