使用引导鞘进行经支气管超声引导下的冷冻活检用于周围型肺病变，并通过下一代测序和快速现场评估进行DNA分析。

Cryobiopsy with endobronchial ultrasonography using a guide sheath for peripheral pulmonary lesions and DNA analysis by next generation sequencing and rapid on-site evaluation.

作者信息

Arimura Ken, Tagaya Etsuko, Akagawa Hiroyuki, Nagashima Yoji, Shimizu Satoru, Atsumi Yoshihide, Sato Akitoshi, Kanzaki Masato, Kondo Mitsuko, Takeyama Kiyoshi, Massion Pierre P, Tamaoki Jun

机构信息

Department of Respiratory Medicine, Tokyo Women׳s Medical University, Tokyo, Japan; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.

Department of Respiratory Medicine, Tokyo Women׳s Medical University, Tokyo, Japan.

出版信息

Respir Investig. 2019 Mar;57(2):150-156. doi: 10.1016/j.resinv.2018.10.006. Epub 2018 Nov 22.

DOI:10.1016/j.resinv.2018.10.006

PMID:30470645

Abstract

BACKGROUND

The purpose of this study was to evaluate the diagnostic accuracy of Cryo with endobronchial ultrasonography using a guide sheath (EBUS-GS) for peripheral pulmonary lesions (PPLs) to assess the volume of specimen, determine DNA sequencing analysis, and evaluate the utility of rapid on-site evaluation (ROSE).

METHODS

Out of 30 patients assessed for eligibility, 23 were enrolled in this prospective study. The histological diagnostic yield of Cryo was evaluated and the volume was compared to that of trans-bronchial biopsy (TBB). DNA analysis of Cryo was performed using next generation sequencing (NGS). ROSE was compared with the final diagnosis.

RESULTS

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy rate was 85%, 100%, 100%, 50%, 87% for Cryo and 80%, 100%, 100%, 42.9%, 82.6% for TBB, respectively. The mean volume was 0.078 cm for Cryo and 0.003 cm for TBB (p < 0.0001). All Cryo specimens provided sufficient quantity and quality of DNA for analysis by NGS. ROSE had a high sensitivity (70%), specificity (100%), PPV (100%), and diagnostic accuracy (73.9%). There were no clinically serious adverse events except mild bleeding in 4 cases.

CONCLUSIONS

Cryo with EBUS-GS for PPLs is a safe and potentially useful diagnostic strategy. It has a high diagnostic yield, and provides significantly larger specimens than TBB. It also provides high quantity and quality of DNA for NGS and high concordance rate between ROSE and the final diagnosis.

摘要

背景

本研究旨在评估使用导向鞘的支气管内超声引导下冷冻活检（EBUS-GS）对周围型肺病变（PPL）的诊断准确性，以评估标本量、进行DNA测序分析并评估快速现场评估（ROSE）的效用。

方法

在30例评估合格的患者中，23例纳入本前瞻性研究。评估冷冻活检的组织学诊断率，并将标本量与经支气管活检（TBB）的标本量进行比较。使用下一代测序（NGS）对冷冻活检标本进行DNA分析。将ROSE结果与最终诊断结果进行比较。

结果

冷冻活检的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确率分别为85%、100%、100%、50%、87%，TBB分别为80%、100%、100%、42.9%、82.6%。冷冻活检的平均标本量为0.078 cm，TBB为0.003 cm（p < 0.0001）。所有冷冻活检标本均提供了足够数量和质量的DNA用于NGS分析。ROSE具有较高的敏感性（70%）、特异性（100%）、PPV（100%）和诊断准确率（73.9%）。除4例轻度出血外，无临床严重不良事件。