Asano Fumihiro
Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu 500-8717, Japan.
Respir Investig. 2016 Jul;54(4):224-9. doi: 10.1016/j.resinv.2015.11.008. Epub 2016 Mar 2.
Bronchoscopy to examine peripheral pulmonary lesions is performed using a bronchoscope with an outer diameter of 5-6mm under fluoroscopy, but the diagnostic yield can be insufficient. Problems with transbronchial biopsy include a limited range of bronchoscope insertion, difficulty in guiding a bronchoscope and biopsy instruments to lesions, and insufficient confirmation of the arrival of biopsy instruments at the target lesion; as such, new techniques have been used to overcome these individual problems. Radial-endobronchial ultrasound is used to identify peripheral pulmonary lesions and sampling sites. In a meta-analysis, the diagnostic yield, that of lesions smaller than 2cm, and complication rate were 73, 56.3, and 1.0%, respectively. Virtual bronchoscopic navigation is a method to guide a bronchoscope to peripheral lesions under direct vision using virtual bronchoscopic images of the bronchial route, and the diagnostic yield, that of 2-cm or smaller lesions, and complication rate were 73.8, 67.4, and 1.0%, respectively. Electromagnetic navigation utilizes electromagnetism; the diagnostic yield was 64.9-71%, and the pneumothorax complication rate was 4% for this modality. Ultrathin bronchoscopes can be advanced to the peripheral bronchus under direct vision in contrast to normal-size bronchoscopes, and the diagnostic yield and pneumothorax complication rates were reported to be 63 and 1.5%, respectively. The overall diagnostic yield of these new techniques on meta-analysis was 70%, a higher yield than that obtained with conventional transbronchial biopsy. Each technique has advantages and disadvantages, and the investigation of appropriate combinations corresponding to individual cases is necessary.
使用外径为5 - 6mm的支气管镜在荧光透视下对周围肺部病变进行支气管镜检查，但诊断率可能不足。经支气管活检存在的问题包括支气管镜插入范围有限、将支气管镜和活检器械引导至病变部位困难以及活检器械到达目标病变的确认不足；因此，已采用新技术来克服这些个别问题。径向支气管内超声用于识别周围肺部病变和采样部位。在一项荟萃分析中，诊断率、小于2cm病变的诊断率以及并发症发生率分别为73%、56.3%和1.0%。虚拟支气管镜导航是一种利用支气管路径的虚拟支气管镜图像在直视下将支气管镜引导至周围病变的方法，其诊断率、2cm或更小病变的诊断率以及并发症发生率分别为73.8%、67.4%和1.0%。电磁导航利用电磁学原理；该方法的诊断率为64.9 - 71%，气胸并发症发生率为4%。与普通尺寸的支气管镜相比，超薄支气管镜可在直视下推进至周围支气管，据报道其诊断率和气胸并发症发生率分别为63%和1.5%。这些新技术在荟萃分析中的总体诊断率为70%，高于传统经支气管活检的诊断率。每种技术都有其优缺点，有必要针对个别病例研究合适的组合方式。
