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.
Thorac Cancer. 2021 Jun;12(12):1864-1872. doi: 10.1111/1759-7714.13995. Epub 2021 May 6.
Transbronchial lung biopsy (TBLB) is usually performed to obtain a definitive diagnosis for peripheral pulmonary lesions (PPLs). Ultrathin bronchoscopy combined with virtual bronchoscopic navigation (VBN) and radial endobronchial ultrasound (R-EBUS) are generally considered appropriate diagnostic methods for PPLs; however, they have not yet been explored in combination with fluoroscopy. Therefore, the present prospective randomized controlled trial determined the role of fluoroscopy in ultrathin bronchoscopy combined with VBN and R-EBUS for the diagnosis of PPLs.
Patients with potentially malignant PPLs were enrolled in the study and randomized into fluoroscopy or nonfluoroscopy groups. In both groups, a 3.0-mm outer and 1.7-mm internal diameter ultrathin bronchoscope was used for transbronchial lung biopsy combined with R-EBUS and VBN. In addition, the fluoroscopy group (FG) underwent fluoroscopy, while the nonfluoroscopy group (NFG) did not.
A total of 126 patients were enrolled and randomized in the study. Among them, 120 patients (60 in the NFG and 60 in the FG) were analyzed. The mean lesion sizes were 26.3 ± 11.4 mm and 29.0 ± 11.3 mm in the NFG and FG, respectively. The diagnostic yield was 73.3% (44/60) in the NFG and 81.7% (49/60) in the FG without statistically significant difference (p = 0.38). No obvious complications occurred in either group.
Ultrathin bronchoscope combined with VBN and R-EBUS without fluoroscopy is a feasible and safe diagnostic method for PPLs.
经支气管肺活检（TBLB）通常用于获得周围性肺病变（PPL）的明确诊断。超细支气管镜联合虚拟支气管镜导航（VBN）和径向支气管内超声（R-EBUS）通常被认为是 PPL 的合适诊断方法；然而，它们尚未与透视结合进行探索。因此，本前瞻性随机对照试验旨在确定透视在超细支气管镜联合 VBN 和 R-EBUS 诊断 PPL 中的作用。
本研究纳入了疑似恶性 PPL 的患者，并将其随机分为透视组或非透视组。两组均采用 3.0mm 外径和 1.7mm 内径的超细支气管镜进行经支气管肺活检联合 R-EBUS 和 VBN。此外，透视组（FG）接受透视检查，而非透视组（NFG）则不进行透视。
共纳入并随机分配了 126 例患者。其中，120 例患者（NFG 组 60 例，FG 组 60 例）纳入分析。NFG 和 FG 组的平均病变大小分别为 26.3±11.4mm 和 29.0±11.3mm。NFG 组的诊断率为 73.3%（44/60），FG 组为 81.7%（49/60），两组间无统计学差异（p=0.38）。两组均未发生明显并发症。
不使用透视的超细支气管镜联合 VBN 和 R-EBUS 是一种可行且安全的 PPL 诊断方法。
