Trkanjec Jasna Tekavec, Peros-Golubicić Tatjana, Grozdek Danijel, Ivicević Antonija, Alilović Marija
University Hospital for Lung Diseases Jordanovac, Zagreb, Croatia.
Coll Antropol. 2003 Dec;27(2):669-75.
Transbronchial lung biopsy (TBLB) is a well-recognized diagnostic technique in diffuse interstitial lung diseases, but it is not considered to be the first choice in investigation of solitary pulmonary nodules (SPN). The main idea of this study was to increase the sensitivity of bronchoscopy using multiple techniques, especially TBLB, thus to avoid more aggressive diagnostic procedures. The objective of this prospective study was to evaluate the efficacy and safety of TBLB in the diagnosis of SPN, in comparison with other bronchoscopic techniques. Fifty patients with chest x-ray finding consistent with SPN underwent bronchoscopy with bronchial washing, brushing, bronchoalveolar lavage (BAL) and TBLB were included in this study. Thirty-one patients suffered from malignant tumors, while 19 patients had nonmalignant lesions. TBLB achieved overall diagnostic sensitivity of 62%, BAL of 29%, bronchial brushing of 16% and washing of 6%. Combining all techniques together, bronchoscopy had overall sensitivity of 86%. Concerning malignant lesions, TBLB had a sensitivity of 65%, specificity of 100%, and accuracy of 82%. TBLB had a significantly better yield for lesions with a diameter > or = 25 mm than for lesions of < 25 mm (sensitivity of 82% and 53% respectively, p < 0.05). Diagnostic yield improved significantly with the increasing number of specimens (less than 3 specimens: sensitivity 59%, 3 or more specimens: sensitivity 87%, p < 0.05). Complications of TBLB occurred in 2 (4%) patients: 1 incomplete pneumothorax and 1 hemorrhage. According to the results, we conclude that TBLB is an accurate and safe technique for the diagnosis of pulmonary solitary nodule with a diameter equal or greater than 25 mm.
经支气管肺活检（TBLB）是弥漫性间质性肺疾病中一种公认的诊断技术，但在孤立性肺结节（SPN）的检查中并非首选。本研究的主要思路是采用多种技术，尤其是TBLB，提高支气管镜检查的敏感性，从而避免采用更具侵袭性的诊断程序。本前瞻性研究的目的是与其他支气管镜技术相比，评估TBLB在SPN诊断中的有效性和安全性。50例胸部X线表现符合SPN的患者接受了支气管镜检查，包括支气管冲洗、刷检、支气管肺泡灌洗（BAL）和TBLB。31例患者患有恶性肿瘤，19例患者有非恶性病变。TBLB的总体诊断敏感性为62%，BAL为29%，支气管刷检为16%，冲洗为6%。将所有技术结合起来，支气管镜检查的总体敏感性为86%。对于恶性病变，TBLB的敏感性为65%，特异性为100%，准确性为82%。直径≥25mm的病变，TBLB的检出率明显高于直径<25mm的病变（敏感性分别为82%和53%，p<0.05）。随着标本数量的增加，诊断率显著提高（少于3个标本：敏感性59%，3个或更多标本：敏感性87%），p<0.05）。2例（4%）患者发生了TBLB并发症：1例不完全气胸和1例出血。根据结果，我们得出结论，TBLB是诊断直径等于或大于25mm的肺孤立结节的一种准确且安全的技术。
