使用超硬支气管镜与硬质支气管镜行经支气管镜针吸活检术诊断肺部外周病变：一项随机试验。

Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions: A Randomized Trial.

机构信息

Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.

Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Gifu, Japan.

出版信息

Chest. 2019 Nov;156(5):954-964. doi: 10.1016/j.chest.2019.06.038. Epub 2019 Jul 26.

DOI:10.1016/j.chest.2019.06.038

PMID:31356810

Abstract

BACKGROUND

When evaluating peripheral pulmonary lesions, a 3.0-mm ultrathin bronchoscope (UTB) with a 1.7-mm working channel is advantageous regarding good access to the peripheral airway, whereas a 4.0-mm thin bronchoscope provides a larger 2.0-mm working channel, which allows the use of various instruments including a guide sheath (GS), larger forceps, and an aspiration needle. This study compared multimodal bronchoscopy using a UTB and a thin bronchoscope with multiple sampling methods for the diagnosis of peripheral pulmonary lesions.

METHODS

Patients with peripheral pulmonary lesions ≤ 30 mm in diameter were recruited and randomized to undergo endobronchial ultrasonography, virtual bronchoscopy, and fluoroscopy-guided bronchoscopy using a 3.0-mm UTB (UTB group) or a 4.0-mm thin bronchoscope (thin bronchoscope group). In the thin bronchoscope group, the use of small forceps with a GS or standard forceps without the GS was permitted. In addition, needle aspiration was performed for lesions into which an ultrasound probe could not be inserted.

RESULTS

A total of 360 patients were enrolled, and 356 were included in the analyses (median largest lesional diameter, 19 mm). The overall diagnostic yield was significantly higher in the UTB group than in the thin bronchoscope group (70.1% vs 58.7%, respectively; P = .027). The procedure duration was significantly shorter in the UTB group (median, 24.8 vs 26.8 min, respectively; P = .008). The complication rates were 2.8% and 4.5%, respectively (P = .574).

CONCLUSIONS

Multimodal bronchoscopy using a UTB afforded a higher diagnostic yield than that using a thin bronchoscope in the diagnosis of small peripheral pulmonary lesions.

TRIAL REGISTRY

UMIN Clinical Trials Registry; No.: UMIN000010133; URL: https://www.umin.ac.jp/ctr/.

摘要

背景

在评估周围性肺病变时，3.0 毫米外径的超细支气管镜（UTB）具有 1.7 毫米工作通道，有利于进入外周气道，而 4.0 毫米外径的纤支镜则提供了更大的 2.0 毫米工作通道，允许使用各种器械，包括导鞘（GS）、更大的钳子和抽吸针。本研究比较了使用 UTB 和纤支镜进行多模态支气管镜检查，并采用多种采样方法诊断周围性肺病变。

方法

纳入了直径≤30 毫米的周围性肺病变患者，并随机分为经支气管超声、虚拟支气管镜和透视引导下使用 3.0 毫米 UTB（UTB 组）或 4.0 毫米纤支镜（纤支镜组）进行支气管镜检查。在纤支镜组中，允许使用带 GS 的小钳子或不带 GS 的标准钳子，如果超声探头无法插入病变部位，则进行针吸。

结果

共纳入 360 例患者，356 例患者纳入分析（最大病变直径中位数为 19 毫米）。UTB 组的总体诊断率明显高于纤支镜组（分别为 70.1%和 58.7%；P=0.027）。UTB 组的操作时间明显短于纤支镜组（中位数分别为 24.8 分钟和 26.8 分钟；P=0.008）。并发症发生率分别为 2.8%和 4.5%（P=0.574）。