Boonsarngsuk Viboon, Kanoksil Wasana, Laungdamerongchai Sarangrat
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia.
Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailandia.
Arch Bronconeumol. 2014 Sep;50(9):379-83. doi: 10.1016/j.arbres.2014.02.018. Epub 2014 Apr 18.
The diagnosis of peripheral pulmonary lesions (PPLs) is a challenging task for pulmonologists. Radial probe endobronchial ultrasound (R-EBUS) has been developed to enhance diagnostic yield. The objective of this study was to evaluate the effectiveness of R-EBUS in the diagnosis of PPLs.
A retrospective study was conducted on 174 patients diagnosed with PPLs who underwent EBUS-guided bronchoscopy. Histological examination of specimens obtained by transbronchial lung biopsy (TBLB) and cytological examinations of brushing smear, brush rinse fluid and bronchoalveolar lavage fluid (BALF) were evaluated for the diagnosis.
The mean diameter of the PPLs was 25.1 ± 10.7 mm. The final diagnoses included 129 malignancies and 45 benign lesions. The overall diagnostic yield of EBUS-guided bronchoscopy was 79.9%. Neither size nor etiology of the PPLs influenced the diagnostic performance of EBUS-guided bronchoscopy (82.9% vs. 74.6% for PPLs>20mm and PPLs≤20mm; p=0.19, and 82.9% vs. 71.1% for malignancy and benign diseases; p=0.09). TBLB rendered the highest yield among these specimens (69.0%, 50.6%, 42.0%, and 44.3% for TBLB, brushing smear, brush rinse fluid, and BALF, respectively; p<0.001). The combination of TBLB, brush smear, and BALF provided the greatest diagnostic yield, while brush rinse fluid did not add benefits to the outcomes.
R-EBUS-guided bronchoscopy is a useful technique in the diagnosis of PPLs. To achieve the highest diagnostic performance, TBLB, brushing smear and bronchoalveolar lavage should be performed together.
对于肺科医生而言，外周肺病变（PPL）的诊断是一项具有挑战性的任务。为提高诊断率，已开发出径向探头支气管内超声（R-EBUS）。本研究的目的是评估R-EBUS在PPL诊断中的有效性。
对174例诊断为PPL并接受EBUS引导下支气管镜检查的患者进行回顾性研究。对经支气管肺活检（TBLB）获取的标本进行组织学检查，并对刷检涂片、刷洗液和支气管肺泡灌洗（BALF）液进行细胞学检查以辅助诊断。
PPL的平均直径为25.1±10.7mm。最终诊断包括129例恶性肿瘤和45例良性病变。EBUS引导下支气管镜检查的总体诊断率为79.9%。PPL的大小和病因均未影响EBUS引导下支气管镜检查的诊断性能（PPL>20mm和PPL≤20mm的诊断率分别为82.9%和74.6%；p=0.19，恶性肿瘤和良性疾病的诊断率分别为82.9%和71.1%；p=0.09）。在这些标本中，TBLB的诊断率最高（TBLB、刷检涂片、刷洗液和BALF的诊断率分别为69.0%、50.6%、42.0%和44.3%；p<0.001）。TBLB、刷检涂片和BALF联合应用可提供最高的诊断率，而刷洗液对诊断结果并无额外益处。
R-EBUS引导下支气管镜检查是诊断PPL的一种有用技术。为获得最高的诊断性能，应同时进行TBLB、刷检涂片和支气管肺泡灌洗。
