University of Calgary, Calgary, Alberta, Canada.
Respirology. 2013 Jul;18(5):784-9. doi: 10.1111/resp.12085.
This study aimed to investigate the diagnostic utility of peripheral endobronchial ultrasound (pEBUS) followed by as-needed electromagnetic navigation bronchoscopy (ENB) for sampling peripheral lung nodules.
The study was a single-arm, prospective cohort study of patients with peripheral lung nodules. Peripheral lung lesion localization was initially performed using a pEBUS probe with guide sheath. If localization failed with pEBUS alone, ENB was used to help identify the lesion. Transbronchial biopsy, bronchial brush, transbronchial needle aspiration and bronchial washings were performed.
Sixty patients were enrolled with average lesion size of 27 mm and mean pleural distance of 20 mm. Lesions were found with pEBUS alone in 75% of cases. The addition of ENB improved lesion localization to 93%. However, diagnostic yield for pEBUS alone and pEBUS with ENB were 43% and 50%, respectively. Factors predicting need for ENB use included smaller lesion size and absence of an air bronchus sign on computed tomography.
ENB improves localization of lung lesions after unsuccessful pEBUS but is often not sufficient to ensure confirmation of a specific diagnosis. Technical improvements in sampling methods could improve the diagnostic yield.
本研究旨在探讨经外周支气管内超声（pEBUS）引导下按需行电磁导航支气管镜（ENB）检查对周围性肺结节取样的诊断价值。
本研究为单臂前瞻性队列研究，纳入周围性肺结节患者。首先使用带导鞘的 pEBUS 探头对周围性肺病变进行定位。如果单独使用 pEBUS 定位失败，则使用 ENB 帮助识别病变。进行经支气管镜活检、支气管刷检、经支气管针吸活检和支气管灌洗。
共纳入 60 例患者，平均病灶大小为 27mm，平均胸膜距离为 20mm。75%的病例单独使用 pEBUS 可发现病灶，而添加 ENB 可将病灶定位提高至 93%。然而，单独使用 pEBUS 和 pEBUS 联合 ENB 的诊断率分别为 43%和 50%。预测需要使用 ENB 的因素包括病灶较小和 CT 上无空气支气管征。
ENB 可改善不成功的 pEBUS 后肺病变的定位，但通常不足以确保明确特定诊断。采样方法的技术改进可以提高诊断率。
