经支气管针吸活检术联合支气管内超声和超细支气管镜检查用于外周肺部病变。
Transbronchial needle aspiration with endobronchial ultrasonography and ultrathin bronchoscopy for peripheral pulmonary lesions.
机构信息
Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.
出版信息
Respir Investig. 2021 Nov;59(6):766-771. doi: 10.1016/j.resinv.2021.04.004. Epub 2021 May 13.
BACKGROUND
Although the efficacy of lung cancer treatment has improved, it is dependent on a reliable diagnosis via bronchoscopy. Transbronchial biopsy using ultrathin bronchoscopy can help detect small peripheral pulmonary lesions (PPLs), with a high diagnostic yield. However, the diagnosis rate using forceps biopsy when the radial endobronchial ultrasonography (rEBUS) probe is adjacent to a lesion tends to be low. Transbronchial needle aspiration (TBNA) may improve the diagnostic yield from adjacent lesions. Recently, PeriView FLEX, a new TBNA needle that can be inserted into ultrathin bronchoscopes, has become available. We examined whether TBNA with PeriView FLEX and forceps biopsy improved adjacent lesion diagnosis when using ultrathin bronchoscopes.
METHODS
We retrospectively examined 51 consecutive patients who underwent TBNA and forceps biopsy using ultrathin bronchoscopes under rEBUS for small PPLs at the Hakodate Goryoukaku Hospital between November 2019 and August 2020. The histological diagnosis rate using TBNA and forceps biopsy, TBNA alone, or forceps biopsy alone was compared between cases where the rEBUS probe was "Within" and "Adjacent To" the lesions.
RESULTS
The diagnosis rate using TBNA and forceps biopsy was 86.3% (95.7% vs. 78.6%; p = 0.08) for all lesions (Within cases vs. Adjacent To cases). The corresponding rate using TBNA alone was 68.6% (69.6% vs. 67.9%; p = 0.57), and that using forceps biopsy alone was 72.5% (91.3% vs. 57.1%; p = 0.0067).
CONCLUSIONS
Forceps biopsy with TBNA during ultrathin bronchoscopy for small PPLs improved the diagnostic yield when lesions were adjacent to the rEBUS probe.
背景
尽管肺癌治疗的疗效有所提高，但仍依赖于支气管镜的可靠诊断。使用超细支气管镜进行经支气管透壁活检可以帮助检测到小的周边肺部病变（PPL），其诊断率较高。然而，当径向支气管内超声（rEBUS）探头与病变相邻时，使用活检钳进行经支气管透壁活检的诊断率往往较低。经支气管针吸活检（TBNA）可能会提高相邻病变的诊断率。最近，一种新的 TBNA 针 PeriView FLEX 可插入超细支气管镜，已投入使用。我们检查了在 rEBUS 下使用超细支气管镜进行 TBNA 和活检钳检查时，PeriView FLEX 与活检钳是否可以改善相邻病变的诊断。
方法
我们回顾性检查了 2019 年 11 月至 2020 年 8 月期间在函馆五棱郭医院接受 rEBUS 引导下超细支气管镜下经支气管透壁活检和活检钳检查的 51 例小 PPL 患者。比较了 rEBUS 探头“within”和“adjacent to”病变时，TBNA 和活检钳、TBNA 或活检钳单独使用时的组织学诊断率。
结果
所有病变的 TBNA 和活检钳诊断率为 86.3%（95.7%比 78.6%；p=0.08）（within 组与 adjacent to 组）。单独使用 TBNA 的诊断率为 68.6%（69.6%比 67.9%；p=0.57），单独使用活检钳的诊断率为 72.5%（91.3%比 57.1%；p=0.0067）。
结论
对于小 PPL，当病变与 rEBUS 探头相邻时，在超细支气管镜下进行 TBNA 联合活检钳检查可提高诊断率。
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