Boonsarngsuk Viboon, Petnak Tananchai, So-Ngern Apichart, Saksitthichok Bancha, Kanoksil Wasana
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Respir Investig. 2020 Sep;58(5):381-386. doi: 10.1016/j.resinv.2020.03.004. Epub 2020 Apr 11.
Data regarding the transbronchial biopsy (TBB) techniques in radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy are limited. The purpose of this study was to compare three R-EBUS-guided TBB techniques for the diagnosis of peripheral pulmonary lesions (PPLs).
A prospective pilot study was conducted including 90 patients with positive bronchus sign PPLs, who underwent R-EBUS-guided TBB. TBB techniques were performed in all patients using small biopsy forceps with a guide sheath (GS). These samples were submitted for both cell block histology (CB) and conventional histology (SB). Standard biopsy forceps were used to collect further samples that were submitted for conventional histology (LB). The diagnostic yields of the three techniques were compared.
The mean diameter of the PPLs was 25.5 ± 8.2 mm and the final diagnoses included 70 malignant and 20 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 82.2%. Although the difference was not statistically significant, CB provided the highest yield of the three TBB techniques: 68.9%, 65.6%, and 62.2% for CB, SB, and LB, respectively (P = 0.20). When the GS was removed and standard biopsy forceps were introduced, misplacement (detected by fluoroscopy) was observed in 24 cases, and LB provided a diagnosis in 11 cases. PPLs ≤20 mm were associated with misplacement (P = 0.003). After the exclusion of misplaced cases, the diagnostic yields were 69.7%, 71.2%, and 68.2% for CB, SB, and LB, respectively (P = 0.65).
Neither the size of biopsy forceps nor the histology process affected the diagnostic yield of R-EBUS-guided bronchoscopy.
关于径向支气管内超声（R-EBUS）引导下支气管镜检查中的经支气管活检（TBB）技术的数据有限。本研究的目的是比较三种R-EBUS引导下的TBB技术对周围型肺部病变（PPL）的诊断价值。
进行了一项前瞻性试点研究，纳入90例支气管征阳性的PPL患者，这些患者均接受了R-EBUS引导下的TBB。所有患者均使用带有导向鞘（GS）的小型活检钳进行TBB技术操作。这些样本同时进行细胞块组织学检查（CB）和传统组织学检查（SB）。使用标准活检钳采集更多样本进行传统组织学检查（LB）。比较这三种技术的诊断率。
PPL的平均直径为25.5±8.2mm，最终诊断包括70例恶性病变和20例良性病变。R-EBUS引导下支气管镜检查的总体诊断率为82.2%。尽管差异无统计学意义，但CB在三种TBB技术中诊断率最高：CB、SB和LB的诊断率分别为68.9%、65.6%和62.2%（P=0.20）。当移除GS并引入标准活检钳时，24例出现误置（通过荧光透视检测），LB在11例中做出了诊断。PPL≤20mm与误置相关（P=0.003）。排除误置病例后，CB、SB和LB的诊断率分别为69.7%、71.2%和68.2%（P=0.65）。
活检钳的大小和组织学处理过程均未影响R-EBUS引导下支气管镜检查的诊断率。
