超声在弥漫性实质性肺疾病经支气管肺冷冻活检术后气胸诊断中的应用。

Ultrasonography for the Diagnosis of Pneumothorax after Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases.

机构信息

Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy.

出版信息

Respiration. 2017;94(2):232-236. doi: 10.1159/000477818. Epub 2017 Jun 22.

DOI:10.1159/000477818

PMID:28637050

Abstract

BACKGROUND

Transbronchial lung cryobiopsy (TBLC) can be indicated in diffuse parenchymal lung diseases (DPLDs) when a confident noninvasive diagnosis cannot be made. The 2 most relevant complications of TBLC are bleeding and pneumothorax (PTX). The accuracy of chest ultrasonography (US) for the detection of PTX is higher when compared to chest X-ray (CXR) with reference to computed tomography (CT) scan as a gold standard.

OBJECTIVE

We evaluated the accuracy of chest US in detecting PTX after TBLC in patients with DPLDs.

METHODS

Patients underwent TBLC during rigid bronchoscopy in deep sedation. Cryobiopsy was performed with fluoroscopic guidance. Three hours later, patients underwent chest US and standard CXR. When there was no concordance between chest US and CXR, chest CT was required.

RESULTS

Forty-three patients were enrolled into the study. Cryobiopsy was performed in the right lung in 36 (84%) patients. PTX was diagnosed in 10 (23%) patients by CXR. There was complete agreement between radiologists interpreting CXR (k = 1, 95% CI 1). Chest US was positive for PTX in 11 (25%) patients. There was complete agreement between pulmonologists interpreting chest US (k = 1, 95% CI 1). The prevalence of PTX diagnosed by concordance of CXR and chest US was 23% (10/43, 95% CI 11.8-38.7). The sensitivity and specificity of chest US were 90% (95% CI 55.5-99.7) and 94% (95% CI 79.8-99.3), respectively. Moreover, the positive and negative predictive values were 82% (95% CI 48-98) and 97% (95% CI 84-100), respectively.

CONCLUSION

Chest US is a highly sensitive and specific diagnostic tool for the diagnosis of PTX after TBLC.

摘要

背景

当无法做出明确的无创诊断时，经支气管肺活检（TBLC）可用于弥漫性实质性肺疾病（DPLD）。TBLC 最相关的两个并发症是出血和气胸（PTX）。与胸部 X 射线（CXR）相比，胸部超声（US）检测 PTX 的准确性更高，而 CT 扫描为金标准。

目的

我们评估了 DPLD 患者接受 TBLC 后胸部 US 检测 PTX 的准确性。

方法

患者在深度镇静下进行硬质支气管镜检查时接受 TBLC。在透视引导下进行冷冻活检。3 小时后，患者进行胸部 US 和标准 CXR。如果胸部 US 和 CXR 不一致，则需要进行胸部 CT。

结果

43 例患者入组研究。36 例（84%）患者在右肺进行冷冻活检。CXR 诊断 10 例（23%）患者存在 PTX。解读 CXR 的放射科医生之间存在完全一致性（k = 1，95%CI 1）。11 例（25%）患者的胸部 US 诊断为 PTX。解读胸部 US 的肺病专家之间存在完全一致性（k = 1，95%CI 1）。通过 CXR 和胸部 US 一致性诊断的 PTX 患病率为 23%（10/43，95%CI 11.8-38.7）。胸部 US 的敏感性和特异性分别为 90%（95%CI 55.5-99.7）和 94%（95%CI 79.8-99.3）。此外，阳性和阴性预测值分别为 82%（95%CI 48-98）和 97%（95%CI 84-100）。