Kuo Chih-Hsi, Lin Shu-Min, Lee Kang-Yun, Chung Fu-Tsai, Lo Yu-Lun, Hsiung Te-Chih, Liu Chien-Ying, Kuo Han-Pin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan.
Eur J Cardiothorac Surg. 2014 May;45(5):894-8. doi: 10.1093/ejcts/ezt472. Epub 2013 Sep 27.
The diagnosis of peripheral pulmonary lesions (PPLs) often involves endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB), washing and brushing. Certain echoic features of PPL have been associated with biopsy yield. This study compared yields of TBB and bronchial washing (TBBW) with those of TBBW plus bronchial brushing and analysed the associations between clinical and echoic features and yield.
We performed a retrospective review of 271 patients undergoing TBB for PPL. TBBW was performed in 139 patients and 132 underwent TBBW plus brushing.
The diagnostic yield of TBBW plus brushing was superior to that of TBBW (80.3 vs 66.2%, P < 0.01). In TBBW patients, lesions <3 cm (57.1 vs 73.7%, P < 0.05), EBUS probe adjacent to the lesion (47.6 vs 74.2%, P < 0.01), continuous margin (56.5 vs 75.7%, P < 0.01) and homogeneous echogenicity (51.0 vs 75.0%, P < 0.01) predicted lower yields, but adding bronchial brushing rendered the diagnostic yields similar, irrespective of EBUS echoic features, leaving lesion size of <3 cm (odds ratio 2.81; 95% confidence interval 1.08-7.31, P < 0.05) as the single independent predictor of lower yield by multivariate regression analysis. TBB plus brushing was not inferior to TBBW plus brushing (78.8 vs 80.3%, P = 0.88).
Bronchial brushing boosted diagnostic yields, particularly for PPLs with echoic features previously associated with a reduced biopsy yield.
外周肺部病变（PPL）的诊断通常涉及支气管内超声（EBUS）引导下的经支气管活检（TBB）、灌洗和刷检。PPL的某些回声特征与活检阳性率相关。本研究比较了TBB联合支气管灌洗（TBBW）与TBBW加支气管刷检的阳性率，并分析了临床和回声特征与阳性率之间的关联。
我们对271例行TBB检查的PPL患者进行了回顾性研究。139例患者进行了TBBW，132例患者进行了TBBW加刷检。
TBBW加刷检的诊断阳性率高于TBBW（80.3%对66.2%，P<0.01）。在TBBW患者中，病变<3 cm（57.1%对73.7%，P<0.05）、EBUS探头靠近病变（47.6%对74.2%，P<0.01）、边界连续（56.5%对75.7%，P<0.01）和均匀回声（51.0%对75.0%，P<0.01）提示阳性率较低，但增加支气管刷检后，无论EBUS回声特征如何，诊断阳性率相似，多因素回归分析显示病变<3 cm（比值比2.81；95%置信区间1.08 - 7.31，P<0.05）是阳性率较低的唯一独立预测因素。TBB加刷检并不逊于TBBW加刷检（78.8%对80.3%，P = 0.88）。
支气管刷检提高了诊断阳性率，特别是对于那些具有先前与活检阳性率降低相关的回声特征的PPL。
