经支气管径向超声引导冷冻活检术在无引导鞘管的情况下对周边肺部病变进行操作。

Radial EBUS-Guided Cryobiopsy of Peripheral Lung Lesions With Flexible Bronchoscopy Without Using Guide-Sheath.

机构信息

Department of Pulmonology, Critical Care and Sleep Medicine.

Departments of Anesthesiology.

出版信息

J Bronchology Interv Pulmonol. 2021 Jul 1;28(3):184-191. doi: 10.1097/LBR.0000000000000768.

DOI:10.1097/LBR.0000000000000768

PMID:33828049

Abstract

BACKGROUND

A guide-sheath (GS) is conventionally used as a conduit for biopsy forceps under the guidance of radial endobronchial ultrasound (REBUS) for sampling the peripheral pulmonary lesions (PPLs). As compared with forceps, the cryoprobe has the advantage of obtaining larger samples. There is a paucity of literature on the use of cryobiopsy for PPL. We evaluated the diagnostic yield and safety of the REBUS-guided cryobiopsy (REBUS-CB) without using GS for the diagnosis of PPL.

METHODS

We retrospectively analyzed the database of 126 patients with PPL between November 2015 and December 2019. The REBUS-CB was performed using a flexible bronchoscopy without GS. Multidisciplinary consensus diagnostic yield was determined and procedural complications were recorded.

RESULTS

The histopathologic diagnosis by REBUS-CB, which is the primary objective of the study was obtained in 99 (78.6%) of total 126 cases. Yield was significantly higher in central lesions as compared to adjacent lesions visualized by the REBUS probe (81.4% versus 53.8%, P=0.021) but not significantly different between large (≥30 mm) and small (<30 mm) lesions (81.6% versus 71.8%, P=0.214). The average largest diameter of biopsy specimens was 6.9 mm (range 1-12, SD 2.132). We witnessed moderate bleeding in 7 (5.6%) and post procedure hypoxic respiratory failure in 4 (3.2%) cases which could be managed without escalation of care.

CONCLUSION

The REBUS-CB from peripheral lung lesions are feasible even without using GS and significantly large samples can be obtained.

摘要

背景

在经径向超声支气管镜（REBUS）引导下，活检钳通常用于引导鞘（GS）作为通道，以对周围性肺病变（PPL）进行取样。与活检钳相比，冷冻探针具有获得更大样本的优势。有关使用冷冻活检对 PPL 进行诊断的文献很少。我们评估了在不使用 GS 的情况下，使用 REBUS 引导冷冻活检（REBUS-CB）对 PPL 进行诊断的诊断率和安全性。

方法

我们回顾性分析了 2015 年 11 月至 2019 年 12 月间 126 例 PPL 患者的数据库。REBUS-CB 是在没有 GS 的情况下使用软性支气管镜进行的。确定多学科共识诊断率并记录程序并发症。

结果

REBUS-CB 获得的组织病理学诊断（这是本研究的主要目的）在 126 例总病例中的 99 例（78.6％）中获得。与通过 REBUS 探头可视化的相邻病变相比，中央病变的诊断率明显更高（81.4％比 53.8％，P=0.021），但在大（≥30mm）和小（<30mm）病变之间差异无统计学意义（81.6％比 71.8％，P=0.214）。活检标本的平均最大直径为 6.9mm（范围 1-12，SD 2.132）。我们观察到 7 例（5.6％）中度出血和 4 例（3.2％）术后缺氧性呼吸衰竭，这些情况无需升级治疗即可得到控制。