Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P. R. China.
Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P. R. China.
Jpn J Clin Oncol. 2021 Apr 1;51(4):622-629. doi: 10.1093/jjco/hyaa245.
Rapid on-site evaluation has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on rapid on-site evaluation combined with transbronchial forceps biopsy in the diagnosis of lung carcinoma is rarely reported. Therefore, we aimed to investigate the value of rapid on-site evaluation during transbronchial forceps biopsy for endoscopically visible (tumor, infiltrative and necrotic) or nonvisible (compressive, nonspecific and normal) malignancy.
A retrospective analysis was performed between January 2015 and January 2019 in Taihe Hospital with 1216 lung cancer patients who underwent bronchoscopy procedures, and these patients were allocated into the rapid on-site evaluation group and non-rapid on-site evaluation group, depending on the timing of the procedure. According to endoscopic features, bronchoscopic appearance was described as endoscopically visible malignancy (tumor, infiltrative and necrotic) and endoscopically nonvisible malignancy (compressive, nonspecific and normal). The diagnostic yield was compared, and the concordance between the rapid on-site evaluation results and the final histology was analyzed.
There was a statistically significant difference in the diagnostic yield between the rapid on-site evaluation and non-rapid on-site evaluation groups for endoscopically nonvisible malignancy (74.3% vs. 51.7%, P < 0.05). However, we found no significant improvement in terms of diagnostic yield for endoscopically visible malignancy (95.2% vs. 91.2%, P > 0.05). The rapid on-site evaluation results showed high-level concordance with histology in the diagnosis of squamous cell carcinoma, adenocarcinoma and small cell carcinoma, with kappa values of 0.749 (P < 0.05), 0.728 (P < 0.05) and 0.940 (P < 0.05), respectively.
The findings demonstrated that the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy (compressive, nonspecific and normal) was significantly improved when rapid on-site evaluation was implemented. In addition, the rapid on-site evaluation results had high-level concordance with the final histological diagnosis.
快速现场评估长期以来一直用于经支气管针吸活检或细针抽吸，以评估周围性肺病变活检材料的充分性。然而，关于快速现场评估与经支气管活检钳联合用于诊断肺癌的研究很少报道。因此，我们旨在研究快速现场评估在经支气管活检钳诊断内镜下可见（肿瘤、浸润性和坏死性）或不可见（压迫性、非特异性和正常）恶性肿瘤中的价值。
回顾性分析 2015 年 1 月至 2019 年 1 月间在泰和医院接受支气管镜检查的 1216 例肺癌患者的资料，根据操作时机将这些患者分为快速现场评估组和非快速现场评估组。根据内镜特征，将支气管镜外观描述为内镜下可见恶性肿瘤（肿瘤、浸润性和坏死性）和内镜下不可见恶性肿瘤（压迫性、非特异性和正常）。比较诊断率，并分析快速现场评估结果与最终组织学的一致性。
对于内镜下不可见恶性肿瘤（压迫性、非特异性和正常），快速现场评估组与非快速现场评估组的诊断率存在统计学差异（74.3% vs. 51.7%，P<0.05）。然而，对于内镜下可见恶性肿瘤（肿瘤、浸润性和坏死性），我们没有发现诊断率有显著提高（95.2% vs. 91.2%，P>0.05）。快速现场评估结果在诊断鳞癌、腺癌和小细胞癌方面与组织学具有高度一致性，kappa 值分别为 0.749（P<0.05）、0.728（P<0.05）和 0.940（P<0.05）。
研究结果表明，在进行快速现场评估时，经支气管活检对内镜下不可见恶性肿瘤（压迫性、非特异性和正常）的诊断率显著提高。此外，快速现场评估结果与最终组织学诊断具有高度一致性。
