Boonsarngsuk Viboon, Kanoksil Wasana, Laungdamerongchai Sarangrat
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2 Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Thorac Dis. 2015 Apr;7(4):697-703. doi: 10.3978/j.issn.2072-1439.2015.04.31.
There are many sampling techniques dedicated to radial endobronchial ultrasound (R-EBUS) guided flexible bronchoscopy (FB). However, data regarding the diagnostic performances among bronchoscopic sampling techniques is limited. This study was conducted to compare the diagnostic yields among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions (PPLs).
A prospective study was conducted on 112 patients who were diagnosed with PPLs and underwent R-EBUS-guided FB between Oct 2012 and Sep 2014. Sampling techniques-including transbronchial biopsy (TBB), brushing cell block, brushing smear, rinsed fluid of brushing, and bronchoalveolar lavage (BAL)-were evaluated for the diagnosis.
The mean diameter of the PPLs was 23.5±9.5 mm. The final diagnoses included 76 malignancies and 36 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 80.4%; TBB gave the highest yield among the 112 specimens: 70.5%, 34.8%, 62.5%, 50.0% and 42.0% for TBB, brushing cell block, brushing smear, rinsed brushing fluid, and BAL fluid (BALF), respectively (P<0.001). TBB provided high diagnostic yield irrespective of the size and etiology of the PPLs. The combination of TBB and brushing smear achieved the maximum diagnostic yield. Of 31 infectious PPLs, BALF culture gave additional microbiological information in 20 cases.
TBB provided the highest diagnostic yield; however, to achieve the highest diagnostic performance, TBB, brushing smear and BAL techniques should be performed together.
有许多采样技术专门用于径向支气管内超声（R-EBUS）引导下的可弯曲支气管镜检查（FB）。然而，关于支气管镜采样技术诊断性能的数据有限。本研究旨在比较支气管镜采样技术在诊断周围型肺病变（PPL）中的诊断率。
对2012年10月至2014年9月期间诊断为PPL并接受R-EBUS引导下FB的112例患者进行了一项前瞻性研究。评估了包括经支气管活检（TBB）、刷检细胞块、刷检涂片、刷检冲洗液和支气管肺泡灌洗（BAL）在内的采样技术用于诊断。
PPL的平均直径为23.5±9.5mm。最终诊断包括76例恶性肿瘤和36例良性病变。R-EBUS引导下支气管镜检查的总体诊断率为80.4%；在112个标本中，TBB的诊断率最高：TBB、刷检细胞块、刷检涂片、刷检冲洗液和BAL液（BALF）的诊断率分别为70.5%、34.8%、62.5%、50.0%和42.0%（P<0.001）。无论PPL的大小和病因如何，TBB都具有较高的诊断率。TBB和刷检涂片联合使用可实现最高诊断率。在31例感染性PPL中，BALF培养在20例中提供了额外的微生物学信息。
TBB的诊断率最高；然而，为了获得最高的诊断性能，应同时进行TBB、刷检涂片和BAL技术。
