Asano Fumihiro, Shinagawa Naofumi, Ishida Takashi, Tsuzuku Akifumi, Tachihara Motoko, Kanazawa Kenya, Yamada Noriyuki, Oizumi Satoshi, Moriya Hiroshi
Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Japan.
Intern Med. 2015;54(9):1021-5. doi: 10.2169/internalmedicine.54.3497. Epub 2015 May 1.
Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful.
The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterior-anterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated.
Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026).
VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.
使用径向支气管内超声（R-EBUS）和虚拟支气管镜导航（VBN）进行支气管镜检查是诊断周围型肺病变的一种有前景的方法。我们之前进行了一项随机对照试验（RCT）（即VBN联合EBUS RCT），纳入了周围型肺病变直径为30mm或更小的患者，发现R-EBUS联合VBN可提高诊断率。在本研究中，我们进行了一项回顾性亚分析，以确定VBN对哪些患者有用。
将VBN联合EBUS RCT的符合方案人群（194例）根据病变大小、病变所在肺叶、病变位置、薄层CT上有无受累支气管（支气管征）以及病变在正位胸片上是否被发现进行分组。研究VBN辅助组（VBNA）和非VBN辅助组（NVBNA）之间诊断率的差异。
在支气管征阳性亚组中，VBNA组和NVBNA组的诊断率分别为94.4%（68/72）和77.8%（56/72），VBNA组的诊断率显著更高（p=0.004；优势比：4.9）。对于小于20mm的病变（94.6%对70.7%；p=0.006）、位于肺野外1/3的病变（95.1%对71.4%；p=0.005）以及在正位胸片上不可见的病变（90.0%对41.7%；p=0.026），诊断率尤其高。
VBN与R-EBUS联合用于评估CT图像上显示有受累支气管的病变时，可提高诊断率。
