超薄冷冻探头在周围型肺磨玻璃影病变诊断中的初步研究。
A pilot study of the ultrathin cryoprobe in the diagnosis of peripheral pulmonary ground-glass opacity lesions.
作者信息
Jiang Simin, Liu Xiaojun, Chen Junxiang, Ma Haifeng, Xie Fangfang, Sun Jiayuan
机构信息
Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Transl Lung Cancer Res. 2020 Oct;9(5):1963-1973. doi: 10.21037/tlcr-20-957.
BACKGROUND
It is very difficult to obtain samples of peripheral pulmonary ground-glass opacity lesions (GGOs) by traditional transbronchial biopsy. This study was conducted to evaluate the diagnostic efficacy and safety of transbronchial cryobiopsy (TBCB) of GGOs using a newly developed ultrathin cryoprobe with an outer diameter of 1.1 mm.
METHODS
We retrospectively analyzed 20 patients with 23 GGOs who underwent TBCB using the ultrathin cryoprobe from October 2018 to November 2019 in the Shanghai Chest Hospital. The TBCB procedure was performed under the guidance of virtual bronchoscopic navigation (VBN), electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound, and fluoroscopy. We collected the baseline information of participants, reported diagnostic yield and complications, and analyzed factors may have affected the diagnostic yield.
RESULTS
A total of 23 GGOs (12 pure GGOs, 11 mixed GGOs), with an average diameter of 21.58±11.88 mm, underwent TBCB, and the diagnostic yield was 82.61% (19/23). Of the 19 GGOs diagnosed by TBCB, 12 were adenocarcinomas, 5 were inflammation, 1 was occupational interstitial lung disease, and 1 was a pulmonary meningothelial-like nodule. The remaining 4 undiagnosed lesions were confirmed to be adenocarcinomas by further analysis. The diagnostic yield was unchanged by factors including size (GGOs ≥20 mm, GGOs <20 mm), navigation (VBN, ENB), fluoroscopic visibility (visible, invisible), GGO-component (pure GGOs, mixed GGOs), and guide sheath (K-201, K203). There was no presentation of pneumothorax or severe hemorrhage.
CONCLUSIONS
The ultrathin cryoprobe is feasible, safe, and has a high diagnostic yield in the diagnosis of pulmonary GGOs. There is vast potential for the ultrathin cryoprobe as a tool for the diagnosis of GGOs, especially for cases suspicious of early-stage lung cancer.
TRIAL REGISTRATION
ClinicalTrials.gov. No: NCT03716284. Registered: 20 October, 2018. URL: ClinicalTrials.gov.
背景
通过传统的经支气管活检获取外周肺磨玻璃样变病灶（GGO）样本非常困难。本研究旨在评估使用新开发的外径为1.1毫米的超薄冷冻探头进行GGO经支气管冷冻活检（TBCB）的诊断效能和安全性。
方法
我们回顾性分析了2018年10月至2019年11月在上海胸科医院使用超薄冷冻探头接受TBCB的20例患者的23个GGO。TBCB手术在虚拟支气管导航（VBN）、电磁导航支气管镜（ENB）、支气管内超声和荧光透视引导下进行。我们收集了参与者的基线信息，报告了诊断率和并发症，并分析了可能影响诊断率的因素。
结果
共对23个GGO（12个纯GGO，11个混合GGO）进行了TBCB，平均直径为21.58±11.88毫米，诊断率为82.61%（19/23）。在经TBCB诊断的19个GGO中，12个为腺癌，5个为炎症，1个为职业性间质性肺病，1个为肺脑膜上皮样结节。其余4个未确诊病变经进一步分析确诊为腺癌。包括大小（GGO≥20毫米，GGO<20毫米）、导航（VBN、ENB）、荧光透视可见性（可见、不可见）、GGO成分（纯GGO、混合GGO）和引导鞘（K-201、K203）等因素对诊断率无影响。未出现气胸或严重出血情况。
结论
超薄冷冻探头在肺GGO诊断中可行、安全且诊断率高。超薄冷冻探头作为GGO诊断工具具有巨大潜力，尤其适用于怀疑早期肺癌的病例。
试验注册
ClinicalTrials.gov。编号：NCT03716284。注册日期：2018年10月20日。网址：ClinicalTrials.gov。
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