锥形束计算机断层扫描增强透视联合支气管内超声在外周肺部病变中的疗效和安全性。

Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions.

机构信息

Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.

Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

出版信息

Respiration. 2021;100(6):538-546. doi: 10.1159/000515181. Epub 2021 Apr 12.

DOI:10.1159/000515181

PMID:33845482

Abstract

BACKGROUND

The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated.

OBJECTIVES

The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS.

METHODS

We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety.

RESULTS

While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; p = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; p = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; p = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm2, respectively.

CONCLUSIONS

TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

摘要

背景

在没有导航系统的情况下，使用径向支气管内超声（EBUS）对周围性肺部病变（PPLs）进行诊断仍然具有挑战性。基于锥束 CT 的增强透视（CBCT-AF）是一种最近开发的技术，其临床应用价值仍有待研究。

目的

本研究旨在探讨 CBCT-AF 联合径向 EBUS 对经支气管镜活检（TBB）的诊断效果。

方法

我们招募了 2018 年 10 月至 2019 年 7 月间连续接受径向 EBUS 引导下 TBB 的 PPLs 患者，这些患者接受了或未接受 AF 治疗。采用倾向评分 1:1 匹配后，我们记录了与该程序相关的数据，并测量了其疗效和安全性。

结果

72 例患者接受了 EBUS 加 AF 治疗，235 例患者仅接受了 EBUS 治疗。经过倾向评分匹配后，我们纳入了 53 对患者。EBUS 加 AF 组和 EBUS 组病变的中位大小分别为 2.8cm 和 2.9cm。前者的诊断率更高（75.5%比 52.8%；p=0.015）。EBUS 加 AF 组对于直径≤30mm 的病变的诊断率显著更高（73.5%比 36.1%；p=0.002）。此外，两组并发症发生率无显著差异（3.8%比 5.7%；p=1.000）。EBUS 加 AF 组有 24 个结节（45.3%）透视下不可见。这些结节在 CBCT 图像上均可识别，并成功标记用于 AF。总操作、CBCT 和透视的平均辐射剂量分别为 19.59、16.4 和 3.17Gycm2。