Novel Combination of a 1.4mm Radiofrequency Ablation Catheter with Ultrathin Bronchoscope for Subpleural Peripheral Lung Tumour Ablation

Bronchoscopic ablation is a promising minimally invasive treatment for peripheral lung tumours, avoiding the high complications associated with percutaneous approaches. However, existing ablation catheters are mostly incompatible with ultrathin bronchoscope (UTB), potentially limiting access to subpleural lesions. We report a case of successful bronchoscopic ablation using a novel 1.4 mm radiofrequency (RF) catheter delivered through a UTB. A 53-year-old woman with oligometastatic gastroesophageal adenocarcinoma underwent bronchoscopic ablation for a 12 mm apical right upper lobe metastasis. The UTB was navigated to the 8th airway generation under direct bronchoscopic vision, and the flexible RF catheter was smoothly inserted through the UTB's 1.7 mm working channel. Real-time cone-beam CT confirmed accurate catheter positioning, ensuring safe ablation without pleural puncture. A total of 26 kJ of energy was delivered over 513 seconds. The patient recovered without complications and was discharged 48 hours post-procedure. The RF catheter's small diameter and high flexibility allow UTB to remain precise and manoeuvrable in the peripheral airway. As peripheral bronchoscopy evolves beyond diagnostics, integrating miniaturized therapeutic tools such as the 1.4mm RF catheter will be crucial in expanding its clinical utility. Further results from ongoing clinical trials are highly anticipated to validate the long-term feasibility and safety of this technique.