Gaeta M, Pandolfo I, Volta S, Russi E G, Bartiromo G, Girone G, La Spada F, Barone M, Casablanca G, Minutoli A
Diagnostic Imaging Service, Piemonte Hospital, Messina, Italy.
AJR Am J Roentgenol. 1991 Dec;157(6):1181-5. doi: 10.2214/ajr.157.6.1950861.
The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.
CT上的支气管征代表有支气管直接通向周围肺部病变。我们对33例经薄层CT（2毫米厚层面）检查证实的周围型支气管肺癌连续病例，研究了该征象在预测经支气管活检和刷检结果方面的价值。CT上可见支气管征的患者有22例，未见支气管征的患者有11例。经支气管活检和刷检显示，CT上可见支气管征的22例患者中有13例（59%）为周围型癌，而未见支气管征的11例患者中只有2例（18%）为周围型癌。差异具有统计学意义（Fisher精确检验，p = 0.029）。按受累支气管的顺序分析，在可见支气管征位于四级支气管的患者中，经支气管活检和刷检的成功率为90%（p = 0.01）。相比之下，当支气管征见于五级、六级或七级分支时，成功率为33%。我们的结果表明，四级支气管处的支气管征在预测经支气管活检和刷检的成功方面具有重要价值。CT上出现该征象可能有助于确定对周围肺部病变患者的检查是否应包括经支气管活检和刷检或经胸针吸活检。
