Cheng Li-Ping, Gu Ye, Gui Xu-Wei, Fang Yong, Wang Hao, Sha Wei
Clinical Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Department of Endoscopy, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Infect Dis Ther. 2020 Mar;9(1):165-174. doi: 10.1007/s40121-020-00283-9. Epub 2020 Feb 25.
Electronic bronchoscopy is invasive and may cause pain. This study aimed to explore the clinical value of virtual bronchoscopic navigation (VBN) in the diagnosis of benign central airway stenosis (CAS) secondary to tracheobronchial tuberculosis (TBT).
Sixty-eight patients with benign CAS caused by TBT were recruited between July 2015 and December 2017. The location, length and diameter of stenoses were independently determined by VBN and electronic bronchoscopy (EOB), and the sensitivity and specificity of VBN in identifying stenosis were assessed with EOB as the gold standard.
In 68 patients with TBT, the overall coincidence between EOB and VBN in the identification of stenosis was 100%. A total of 188 sites were selected from the central airway, and the stenosis was graded into 0%, ≤ 25%, 26-50%, 51-75%, 76-90% and > 90%. The sensitivity of VBN in determining the degree of stenosis was 98.45%, 100.00%, 100.00%, 100.00%, 84.62% and 0.00%, respectively; the specificity was 91.53%, 96.07%, 97.09%, 97.08%, 97.14% and 97.30%, respectively; the accuracy rate was 96.28%, 96.28%, 97.34%, 97.34%, 96.28% and 95.7%, respectively. The length of airway stenosis on EOB was divided into < 10 mm, 10-30 mm, 30-50 mm and > 50 mm. There was no significant difference in the length of airway stenosis between VBN and EOB (t = 0.083, P = 0.936; t = 1.340, P = 0.199; t = 1.297, P = 0.216; t = 2.186, P = 0.081). In three patients who received stent placement, VBN was able to accurately assess the postoperative expansion.
VBN is helpful for the diagnosis of TBT-induced CBS and may provide important information on the location, length, diameter and cross-sectional area of stenosis for further EOB examination and interventional therapy. VBN is recommended for patients with TBT and those with contradictions to bronchoscopy, as well as for regular follow-up of stable TBT, because it reduces the incidence of injury, avoids repeat operations and shortens treatment time.
电子支气管镜检查具有侵入性，可能会引起疼痛。本研究旨在探讨虚拟支气管镜导航（VBN）在诊断气管支气管结核（TBT）继发的良性中央气道狭窄（CAS）中的临床价值。
选取2015年7月至2017年12月期间68例由TBT引起的良性CAS患者。由VBN和电子支气管镜检查（EOB）独立确定狭窄的位置、长度和直径，并以EOB作为金标准评估VBN在识别狭窄方面的敏感性和特异性。
在68例TBT患者中，EOB和VBN在识别狭窄方面的总体符合率为100%。从中央气道共选取188个部位，将狭窄程度分为0%、≤25%、26 - 50%、51 - 75%、76 - 90%和>90%。VBN在确定狭窄程度方面的敏感性分别为98.45%、100.00%、100.00%、100.00%、84.62%和0.00%；特异性分别为91.53%、96.07%、97.09%、97.08%、97.14%和97.30%；准确率分别为96.28%、96.28%、97.34%、97.34%、96.28%和95.7%。EOB检查的气道狭窄长度分为<10 mm、10 - 30 mm、30 - 50 mm和>50 mm。VBN与EOB检查的气道狭窄长度差异无统计学意义（t = 0.083，P = 0.936；t = 1.340，P = 0.199；t = 1.297，P = 0.216；t = 2.186，P = 0.081）。3例接受支架置入的患者中，VBN能够准确评估术后扩张情况。
VBN有助于诊断TBT引起的CBS，并可为进一步的EOB检查和介入治疗提供关于狭窄位置、长度、直径和横截面积的重要信息。对于TBT患者、存在支气管镜检查禁忌证者以及稳定期TBT的定期随访患者，推荐使用VBN，因为它可降低损伤发生率，避免重复操作并缩短治疗时间。
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