Sánchez-Font Albert, Giralt Laia, Vollmer Ivan, Pijuan Lara, Gea Joaquim, Curull Víctor
Servei de Pneumologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), ISCIII, Barcelona, España.
Servei de Pneumologia, Hospital del Mar - Parc de Salut Mar, Universitat Autònoma de Barcelona y Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias (CibeRes), ISCIII, Barcelona, España.
Arch Bronconeumol. 2014 May;50(5):166-71. doi: 10.1016/j.arbres.2013.11.019. Epub 2014 Jan 15.
Fluoroscopy-guided bronchoscopy is usually performed for the diagnosis of peripheral pulmonary lesions (PPL), but the diagnostic yield varies widely among studies. Endobronchial ultrasound (EBUS) can increase the diagnostic yield of bronchoscopic diagnosis of PPL.
To compare the diagnostic yield of fluoroscopy-guided bronchoscopy and EBUS with fluoroscopy-guided bronchoscopy in the study of PPL.
All patients who underwent bronchoscopy to study PPL from January 2009 to December 2012 were prospectively included. 145 consecutive patients were randomly distributed in two groups: EBUS and fluoroscopy (50 patients, 71.3 ± 8.2 years) or fluoroscopy alone (95 patients, 68 ± 10.5 years). The mean diameter of the lesions was 41.97 ± 19.22 mm. Cytological brushing and transbronchial biopsies were obtained. All procedures were performed under fluoroscopic guidance with intravenous conscious sedation. EBUS was performed using an endoscopic ultrasound system equipped with a 20-MHz radial miniprobe introduced via a guide-sheath. Bronchoscopist, cytologist, study protocol, techniques and tools were the same throughout the whole study.
129 (89%) patients had malignant disease. A diagnosis with bronchoscopy was established in 105 (72.4%) patients. EBUS plus fluoroscopy obtained a diagnostic yield in 78% of patients and fluoroscopy alone in 69.5% (non-significant). In contrast, for lesions smaller than 30 mm, EBUS plus fluoroscopy guidance provided significantly greater diagnostic performance than fluoroscopy alone (90 vs. 52%; P=.05).
Bronchoscopy under EBUS plus fluoroscopy guidance is a technique that has become useful for the diagnostic of LPPs, especially those smaller than 30 mm in diameter.
荧光透视引导下的支气管镜检查通常用于诊断周围型肺部病变（PPL），但不同研究中的诊断率差异很大。支气管内超声（EBUS）可提高PPL支气管镜诊断的诊断率。
比较荧光透视引导下支气管镜检查与荧光透视引导下EBUS在PPL研究中的诊断率。
前瞻性纳入2009年1月至2012年12月期间接受支气管镜检查以研究PPL的所有患者。145例连续患者随机分为两组：EBUS联合荧光透视组（50例，年龄71.3±8.2岁）和单纯荧光透视组（95例，年龄68±10.5岁）。病变的平均直径为41.97±19.22mm。获取了细胞学刷检和经支气管活检标本。所有操作均在荧光透视引导下进行，并给予静脉清醒镇静。使用配备20MHz径向微型探头的内镜超声系统通过引导鞘进行EBUS检查。在整个研究过程中，支气管镜医师、细胞学家、研究方案、技术和工具均相同。
129例（89%）患者患有恶性疾病。105例（72.4%）患者通过支气管镜检查确诊。EBUS联合荧光透视组的诊断率为78%，单纯荧光透视组为69.5%（无显著差异）。相比之下，对于直径小于30mm的病变，EBUS联合荧光透视引导的诊断性能明显优于单纯荧光透视（90%对52%；P = 0.05）。
EBUS联合荧光透视引导下的支气管镜检查是一种对LPPs诊断有用的技术，尤其是对于直径小于30mm的病变。
