Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Ann Thorac Surg. 2012 Mar;93(3):944-9; discussion 949-50. doi: 10.1016/j.athoracsur.2011.11.006. Epub 2012 Jan 23.
Multiple studies by pulmonologists have demonstrated that electromagnetic navigation bronchoscopy (ENB) can, with high diagnostic yields and low complication rates, diagnose pulmonary lesions. We believe thoracic surgeons can perform this technique with excellent early results.
A retrospective analysis was conducted of the first consecutive 104 patients undergoing diagnostic ENB by 2 thoracic surgeons between April 2008 and October 2009. Procedures utilized general anesthesia and rapid on-site examination (ROSE) of cytopathology. All pulmonary lesions were suspicious for malignancy. Patients having negative biopsies subsequently underwent additional procedures or follow-up imaging. True negative biopsies were defined as lesions removed surgically and proven benign, lesions that disappeared on subsequent imaging, and lesions demonstrating stability over a 2-year period.
Of 104 patients, 3 were excluded due to insufficient follow-up. The remaining 101 patients had a median lesion size of 2.8 cm. Sixty-seven (82%) of the 82 lesions that were determined malignant had a positive diagnosis upon ENB. Of the 34 lesions without a positive ENB biopsy, 19 (56%) were categorized as true negatives: 8 had benign surgical biopsies, 6 disappeared, and 5 demonstrated stability. Consequently, 86 of 101 cases had an accurate ENB biopsy for a diagnostic yield of 85%. There was insufficient evidence to demonstrate an association between lesion size and diagnostic accuracy. There were 6 pneumothoraces (5.8%).
It is possible for thoracic surgeons to perform ENB with early success. The high diagnostic yields in this study may be attributed to the routine utilization of ROSE and general anesthesia, which preserves computed tomographic-to-body divergence.
多位肺病专家的研究表明，电磁导航支气管镜（ENB）可以以较高的诊断率和较低的并发症率诊断肺部病变。我们认为胸外科医生可以通过出色的早期结果来实施该技术。
回顾性分析了 2 位胸外科医生于 2008 年 4 月至 2009 年 10 月期间对 104 例连续诊断性 ENB 患者的资料。手术过程采用全身麻醉和快速现场细胞学检查（ROSE）。所有肺部病变均疑似恶性肿瘤。活检阴性的患者随后接受了额外的检查或随访影像学检查。真正的阴性活检定义为经手术切除并证实为良性的病变、在随后的影像学检查中消失的病变，以及在 2 年期间保持稳定的病变。
104 例患者中有 3 例因随访时间不足而被排除。其余 101 例患者的中位病变大小为 2.8cm。在 82 个被确定为恶性的病变中，有 67 个（82%）在 ENB 中得到了阳性诊断。在 34 个 ENB 活检未阳性的病变中，有 19 个（56%）被归类为真正的阴性：8 个有良性手术活检，6 个病变消失，5 个病变稳定。因此，101 例中有 86 例获得了准确的 ENB 活检，诊断率为 85%。没有足够的证据表明病变大小与诊断准确性之间存在关联。有 6 例气胸（5.8%）。
胸外科医生可以成功实施 ENB。本研究中的高诊断率可能归因于常规使用 ROSE 和全身麻醉，这保留了 CT 与身体的发散。
