电磁导航支气管镜引导下经皮肺外周病变细针抽吸术：50 例病变的初步结果。

The emerging technique of electromagnetic navigation bronchoscopy-guided fine-needle aspiration of peripheral lung lesions: promising results in 50 lesions.

机构信息

Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.

出版信息

Cancer Cytopathol. 2014 Mar;122(3):191-9. doi: 10.1002/cncy.21373. Epub 2013 Dec 5.

DOI:10.1002/cncy.21373

PMID:24323803

Abstract

BACKGROUND

Literature on the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) with ENB-guided fine-needle aspiration (ENB-FNA) in peripheral lung lesions (PLLs) that measure ≤ 2 cm is scarce. Data on the diagnostic yield of ENB-FNA for PLLs when performed in conjunction with positron emission tomography-computed tomography (PET-CT), rapid on-site evaluation (ROSE), ENB-guided bronchial brushing (ENB-BB), and ENB-guided transbronchial biopsy (ENB-TBx) is also limited. In this study, the authors evaluated their experience with ENB-FNA performed in conjunction with all 4 modalities: PET-CT, ROSE, ENB-BB, and ENB-TBx.

METHODS

ENB-FNA and other tests over a 2-year-period (from July 2011 to July 2013) were retrospectively reviewed.

RESULTS

There were 50 PLLs from 40 patients, and the mean lesion size (available for 45 PLLs) was 2.6 cm: these included 24 PLLs that measured ≤ 2 cm and 21 PLLs that measured > 2.0 cm. The ENB-FNA diagnosis was malignant in 17 lesions, atypical in 1 lesion, benign in 31 lesions, and nondiagnostic in 1 lesion. On the basis of lesion size, the diagnostic yield of PLLs was 87% in lesions ≤ 2 cm and 100% in lesions > 2.0 cm (P = 0.5; not significant). Follow-up available in 49 of 50 PLLs from 39 patients had an overall diagnostic yield of 94% for ENB-FNA. The diagnostic yield of PET-CT (available in 31 of 50 PLLs) and of ENB-BB and ENB-TBx (available in 40 of 50 PLLs) in conjunction with ENB-FNA was 61% and 95%, respectively. ROSE was performed in 46 of 50 PLLs: the overall sensitivity of ROSE and ENB-FNA was 85% and 89.4%, respectively, and their specificity was 96.5% and 100%, respectively. There were no procedure-related complications.

CONCLUSIONS

The high overall diagnostic yield of 94% and fewer complications make ENB-FNA a useful modality for the assessment of PLLs. In this study, ROSE was useful, whereas PET-CT, ENB-BB, and ENB-TBx were not useful in the evaluation of PLLs.

摘要

背景

关于电磁导航支气管镜（ENB）引导下细针抽吸（ENB-FNA）在测量直径≤2cm 的外周肺部病变（PLL）中的诊断效能的文献很少。关于在正电子发射断层扫描-计算机断层扫描（PET-CT）、现场快速评估（ROSE）、ENB 引导下支气管刷检（ENB-BB）和 ENB 引导下经支气管活检（ENB-TBx）联合应用下，ENB-FNA 对 PLL 的诊断效能的数据也很有限。在这项研究中，作者评估了他们在 4 种模式联合应用下进行 ENB-FNA 的经验：PET-CT、ROSE、ENB-BB 和 ENB-TBx。

方法

回顾性分析了 2 年内（2011 年 7 月至 2013 年 7 月）进行的 ENB-FNA 和其他检查。

结果

共有 40 例患者的 50 个 PLL，平均病变大小（45 个 PLL 中可测量）为 2.6cm：其中 24 个 PLL 测量直径≤2cm，21 个 PLL 测量直径＞2.0cm。ENB-FNA 诊断恶性病变 17 例，不典型病变 1 例，良性病变 31 例，无法诊断 1 例。根据病变大小，≤2cm 的 PLL 诊断率为 87%，＞2.0cm 的 PLL 诊断率为 100%（P=0.5；无统计学意义）。在 39 例患者的 50 个 PLL 中，49 个可获得随访，ENB-FNA 的总体诊断率为 94%。PET-CT（31 个 PLL 中可获得）和 ENB-BB 和 ENB-TBx（40 个 PLL 中可获得）联合 ENB-FNA 的诊断率分别为 61%和 95%。ROSE 在 50 个 PLL 中进行了 46 次：ROSE 和 ENB-FNA 的总敏感性分别为 85%和 89.4%，特异性分别为 96.5%和 100%。无手术相关并发症。