Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
Chest. 2020 Jun;157(6):1656-1664. doi: 10.1016/j.chest.2019.12.024. Epub 2020 Jan 21.
Bronchoscopy is commonly used to evaluate suspicious lung lesions. The yield is likely dependent on patient, radiographic, and bronchoscopic factors. Few studies have assessed these factors simultaneously while also including the preprocedure physician-assessed probability of cancer (pCA) when assessing yield.
This study is a secondary data analysis from a prospective multicenter trial. Diagnostic yield of standard bronchoscopy with biopsy ± fluoroscopy, endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), electromagnetic navigation, and combination bronchoscopies was assessed. Definitions for diagnostic and nondiagnostic bronchoscopies were rigorously predefined. The association of diagnostic yield with individual variables was examined by using univariate and multivariate logistic regression analyses where appropriate.
A total of 687 patients were included from 28 sites. Overall diagnostic yield was 69%; 80% for EBUS, 55% for bronchoscopy with biopsy ± fluoroscopy, 57% for electromagnetic navigation, and 74% for combination procedures (P < .001). Patients with larger, central lesions with adenopathy were significantly more likely to undergo a diagnostic bronchoscopy. Patients with pCA < 10% and 10% to 60% had lower yields (44% and 42%, respectively), whereas pCA > 60% yielded a positive result in 77% (P < .001). In multivariate logistic regression, the use of EBUS-TBNA, larger sized lesions, and central location were significantly associated with a diagnostic bronchoscopy. Seventeen percent of those with a malignant diagnosis and 28% of those with a benign diagnosis required secondary procedures to establish a diagnosis.
This study is the first to assess the yield of bronchoscopy according to physician-assessed pCA in a large, prospective multicenter trial. The yield of bronchoscopy varied greatly according to physician suspicion that cancer is present, the patients' clinical/radiographic features, and the type of procedure performed. Of the procedures performed, EBUS-TBNA was the most likely to provide a diagnosis.
支气管镜检查常用于评估可疑肺部病变。其检出率可能取决于患者、影像学和支气管镜检查因素。很少有研究在评估检出率时同时评估这些因素，还包括术前医生评估的癌症可能性（pCA）。
本研究是一项前瞻性多中心试验的二次数据分析。评估了标准支气管镜活检±透视、支气管内超声引导经支气管针吸活检（EBUS-TBNA）、电磁导航和联合支气管镜检查的诊断率。严格预先定义了诊断性和非诊断性支气管镜检查的定义。使用单变量和多变量逻辑回归分析适当评估了诊断性与个体变量的关联。
共纳入 28 个中心的 687 例患者。总体诊断率为 69%；EBUS 为 80%，支气管镜活检±透视为 55%，电磁导航为 57%，联合手术为 74%（P <.001）。较大的、中央病变伴淋巴结肿大的患者更有可能进行诊断性支气管镜检查。pCA < 10%和 10%至 60%的患者检出率较低（分别为 44%和 42%），而 pCA > 60%的患者阳性检出率为 77%（P <.001）。多变量逻辑回归分析显示，使用 EBUS-TBNA、较大病变和中央位置与诊断性支气管镜检查显著相关。17%的恶性诊断和 28%的良性诊断患者需要进行二次手术以明确诊断。
本研究是第一项在大型前瞻性多中心试验中根据医生评估的 pCA 评估支气管镜检查检出率的研究。支气管镜检查的检出率根据医生对癌症存在的怀疑程度、患者的临床/影像学特征和所进行的操作类型而有很大差异。在所进行的操作中，EBUS-TBNA 最有可能提供诊断。
