Sumi Toshiyuki, Ikeda Takumi, Sawai Takeyuki, Shijubou Naoki, Kure Kenichi, Yamada Yuichi, Nakata Hisashi, Mori Yuji, Takahashi Hiroki
Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Japan.
Department of Pulmonary Medicine, Kushiro General Hospital, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Japan.
Respir Investig. 2020 Sep;58(5):376-380. doi: 10.1016/j.resinv.2020.03.001. Epub 2020 Apr 1.
For the precise management of advanced lung cancers, bronchoscopy with a high diagnostic yield and abundant tumor specimens are required. In recent years, new devices and techniques have been rapidly developed, including the endobronchial ultrasound (EBUS) using a guide sheath, virtual bronchoscopic navigation (VBN), and ultra-thin bronchoscope (UTB), for the diagnosis of peripheral pulmonary lesions (PPLs). These techniques increase the diagnostic yield for PPL, thus requiring fewer biopsy specimens. VBN is generally not available at the city hospitals in Japan. In this study, using fluoroscopy without VBN, we studied whether the histologic diagnostic yield of radial EBUS for PPLs would be higher using a UTB (without guide sheath) or conventional bronchoscope (CB) (with guide sheath).
We retrospectively reviewed consecutive patients with suspected lung cancer who underwent bronchoscopy at the Hakodate Goryoukaku Hospital from April 2017 to March 2019. We analyzed 168 patients-102 using UTB and 66 using CB.
The diagnostic yields for PPL were significantly higher in the UTB group than in the CB group (74.5% vs. 59.1%; P = 0.04). The median examination time was significantly longer in the UTB group than in the CB group (24 vs. 20 min; P = 0.01). There were no statistically significant differences in the complication rate between the UTB and CB groups (3.9% vs. 3.0%; P = 0.69).
UTB had a significantly higher tissue diagnostic yield than CB, without the use of VBN.
对于晚期肺癌的精确管理，需要具有高诊断率和丰富肿瘤标本的支气管镜检查。近年来，包括使用引导鞘的支气管内超声（EBUS）、虚拟支气管镜导航（VBN）和超薄支气管镜（UTB）在内的新设备和技术迅速发展，用于诊断周围型肺病变（PPL）。这些技术提高了PPL的诊断率，因此所需的活检标本更少。在日本的城市医院中，VBN通常无法使用。在本研究中，我们在不使用VBN的情况下利用荧光透视法，研究了使用UTB（无引导鞘）或传统支气管镜（CB，有引导鞘）时，径向EBUS对PPL的组织学诊断率是否会更高。
我们回顾性分析了2017年4月至2019年3月在函馆五棱郭医院接受支气管镜检查的连续疑似肺癌患者。我们分析了168例患者，其中102例使用UTB，66例使用CB。
UTB组PPL的诊断率显著高于CB组（74.5%对59.1%；P = 0.04）。UTB组的中位检查时间显著长于CB组（24分钟对20分钟；P = 0.01）。UTB组和CB组之间的并发症发生率无统计学显著差异（3.9%对3.0%；P = 0.69）。
在不使用VBN的情况下，UTB的组织诊断率显著高于CB。
