Sheski Francis D, Mathur Praveen N
Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Chest. 2008 Jan;133(1):264-70. doi: 10.1378/chest.06-1735.
During flexible fiberoptic bronchoscopy (FB), a solitary pulmonary nodule (SPN) is sampled by means of transbronchial needle aspiration (TBNA), brush, or transbronchial lung biopsy under fluoroscopy; and mediastinal lymph nodes are sampled using "blind" TBNA. Endobronchial ultrasound (EBUS) was developed to help visualize the lesion at the time of biopsy in order to improve the diagnostic yield.
There are two types of EBUS techniques: using a radial probe (RP) with a rotating transducer at the distal tip, which produces a 360 degrees image to the long axis of the bronchoscope; and using an EBUS bronchoscope with a linear transducer at its distal tip, producing a 50 degrees image parallel to its long axis.
In biopsies of SPNs < 2 cm using an RP, EBUS demonstrates a higher diagnostic yield than conventional FB techniques. With mediastinal and hilar nodal stations, except for the subcarina, EBUS shows a higher yield over blind TBNA. The current procedural terminology code for EBUS is 31620, a "ZZZ" code submitted in addition to other performed procedures (31622-31638). In 2007, an estimate of physician Medicare reimbursement for EBUS is $70.49. Reimbursement is locality dependent and based on economic-exchange conversion factors. Incorporating an ultrasound image into the report substantiates the use of this technique.
The physician must learn ultrasound image interpretation and the EBUS technique, and be skilled in TBNA. Maintaining competency requires frequent performance of EBUS.
EBUS-directed biopsy improves the yield over conventional FB for SPNs < 2 cm and for most mediastinal or hilar nodal stations. This reduces the need to conduct additional diagnostic procedures.
在可弯曲纤维支气管镜检查（FB）期间，通过透视下经支气管针吸活检（TBNA）、刷检或经支气管肺活检对孤立性肺结节（SPN）进行采样；并使用“盲法”TBNA对纵隔淋巴结进行采样。为了提高诊断率，开发了支气管内超声（EBUS）以在活检时帮助可视化病变。
EBUS技术有两种类型：使用远端尖端带有旋转换能器的径向探头（RP），可产生与支气管镜长轴呈360度的图像；以及使用远端尖端带有线性换能器的EBUS支气管镜，可产生与其长轴平行的50度图像。
在使用RP对直径<2 cm的SPN进行活检时，EBUS显示出比传统FB技术更高的诊断率。对于纵隔和肺门淋巴结站，除隆突下外，EBUS显示出比盲法TBNA更高的诊断率。EBUS当前的程序术语编码为31620，是在执行的其他程序（31622 - 31638）之外提交的“ZZZ”编码。2007年，医生进行EBUS的医疗保险报销估计为70.49美元。报销取决于地区，并基于经济兑换转换因子。在报告中纳入超声图像可证实该技术的使用。
医生必须学习超声图像解读和EBUS技术，并且熟练掌握TBNA。保持能力需要频繁进行EBUS操作。
对于直径<2 cm的SPN以及大多数纵隔或肺门淋巴结站，EBUS引导下的活检比传统FB具有更高的诊断率。这减少了进行额外诊断程序的必要性。
