在经验不足的肺科医生中，无荧光透视引导的虚拟支气管镜导航用于外周肺部病变
Virtual bronchoscopic navigation without fluoroscopy guidance for peripheral pulmonary lesions in inexperienced pulmonologist.
作者信息
Li Shijie, Yan Wanpu, Chen Mailin, Li Zhongwu, Zhu Yanli, Wu Qi
机构信息
First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832008, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Endoscopy Center, Peking University Cancer Hospital & Institute, Beijing 100142, China.
出版信息
Chin J Cancer Res. 2020 Aug;32(4):530-539. doi: 10.21147/j.issn.1000-9604.2020.04.10.
OBJECTIVE
Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath (EBUS-GS) in peripheral pulmonary lesions (PPLs). Virtual bronchoscopic navigation (VBN) can guide the bronchoscope by creating virtual images of the bronchial route to the lesion. The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.
METHODS
Between January 2016 and June 2017, consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled. The diagnostic yield as well as safety profiles was retrospectively analyzed, and our preliminary experience was shared.
RESULTS
A total of 109 patients with 109 lesions were included, 99 (90.8%) lesions were visible on EBUS imaging. According to the procedure time needed to locate the lesion on EBUS, 24.8% (27/109) were deemed technically difficult procedures; however, no significant relationships were identified between candidate parameters and technically difficult procedures. The overall diagnosis yield was 74.3% (81/109), and the diagnostic yield of malignancy was 83.7% (77/92). Lesions larger than 20 mm [odds ratio (OR), 2.758; 95% confidence interval (95% CI), 1.077-7.062; P=0.034] and probe of within type (OR, 3.174; 95% CI, 1.151-8.757, P=0.026) were independent factors leading to a better diagnostic yield in multivariate analysis. About 30 practice procedures were needed to achieve a stable diagnostic yield, and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures. Regarding complications, one patient (0.9%) had intraoperative hemorrhage (100 mL) which was managed under endoscopy.
CONCLUSIONS
VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis, especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS. VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.
目的
对于外周肺部病变（PPL）的支气管内超声引导鞘管技术（EBUS-GS），通常需要荧光透视引导。虚拟支气管镜导航（VBN）可通过创建通往病变的支气管路径的虚拟图像来引导支气管镜。在没有经验的肺科医生进行EBUS-GS时，未对无荧光透视的VBN用于PPL的诊断率和安全性进行评估。
方法
2016年1月至2017年6月，纳入在单一癌症中心因EBUS-GS而转诊的连续PPL患者。回顾性分析诊断率和安全性，并分享我们的初步经验。
结果
共纳入109例患者的109个病变，99个（90.8%）病变在EBUS成像上可见。根据在EBUS上定位病变所需的操作时间，24.8%（27/109）被视为技术难度较大的操作；然而，在候选参数与技术难度较大的操作之间未发现显著相关性。总体诊断率为74.3%（81/109），恶性病变的诊断率为83.7%（77/92）。在多因素分析中，大于20 mm的病变[比值比（OR），2.758；95%置信区间（95%CI），1.077 - 7.062；P = 0.034]和内置型探头（OR，3.174；95%CI，1.151 - 8.757，P = 0.026）是导致更好诊断率的独立因素。需要约30次实际操作才能达到稳定的诊断率，并且在70次实际操作后技术难度较大的操作比例下降并稳定。关于并发症，1例患者（0.9%）发生术中出血（100 mL），在内镜下得到处理。
结论
无荧光透视引导的VBN对于PPL诊断仍然有用且安全，特别是对于由没有EBUS-GS经验的肺科医生进行的恶性疾病诊断。VBN可能会简化病变定位过程，有必要进一步开展多中心随机研究。
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