Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Lung Cancer. 2021 Nov;161:1-8. doi: 10.1016/j.lungcan.2021.08.016. Epub 2021 Aug 31.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure, but little is known about its infectious complications. The aim of this study is to evaluate the incidence and risk factors of infectious complications of EBUS-TBNA and its clinical course, including effects on anti-cancer treatment.
This is a nested case-control study of patients who received EBUS-TBNA and were followed for at least 2 months at Samsung Medical Center from August 2009 to April 2019. Patients with clinical symptoms of infection and correlating chest images were defined as the infection group (n = 33). The controls were randomly selected from patients without infectious complication. Multivariate logistic regression with backward selection was used to identify the risk factors of infectious complications.
Of the 6826 patients, 33 (0.48%) infectious complications were identified, comprising pneumonia (n = 20) and mediastinal infections (n = 13). Target lesions with necrotic features on chest computed tomography (CT) scan (adjusted odds ratio [aOR], 3.08; 95% confidence interval [CI], 1.49-6.40; P = 0.002) and procedures that were performed via the esophagus (aOR, 3.19; 95% CI, 1.47-6.88; P = 0.003) were independently associated with infectious complications. Among patients ultimately diagnosed with cancer, the infection group tended to refuse anti-cancer treatment compared to controls (32/459, 7.0% vs. 5/30, 16.7%; P = 0.066). However, among the patients who received anti-cancer treatment, there was no delay in onset of treatment.
Infectious complications of EBUS-TBNA are rare; however, attention should be paid if the target lesion appears necrotic on chest CT or if the procedure is performed via the esophagus. Although it was not conclusive due to its rarity, patients with infectious complications tended not to receive anti-cancer treatment.
支气管内超声引导经支气管针吸活检术（EBUS-TBNA）已成为一种标准程序，但对于其感染并发症知之甚少。本研究旨在评估 EBUS-TBNA 的感染并发症发生率及危险因素，以及其临床过程，包括对癌症治疗的影响。
这是一项在三星医疗中心 2009 年 8 月至 2019 年 4 月期间接受 EBUS-TBNA 并至少随访 2 个月的患者的巢式病例对照研究。有感染症状且胸部影像相关的患者被定义为感染组（n=33）。对照组为无感染并发症的患者随机选择。采用向后选择的多变量逻辑回归来确定感染并发症的危险因素。
在 6826 例患者中，发现 33 例（0.48%）感染并发症，包括肺炎（n=20）和纵隔感染（n=13）。胸部 CT 扫描显示有坏死特征的靶病变（调整后的优势比[aOR]，3.08；95%置信区间[CI]，1.49-6.40；P=0.002）和经食管进行的操作（aOR，3.19；95%CI，1.47-6.88；P=0.003）与感染并发症独立相关。在最终诊断为癌症的患者中，感染组与对照组相比，更倾向于拒绝癌症治疗（32/459，7.0%比 5/30，16.7%；P=0.066）。然而，在接受癌症治疗的患者中，治疗开始并没有延迟。
EBUS-TBNA 的感染并发症罕见；然而，如果胸部 CT 显示靶病变坏死或操作经食管进行，应予以关注。由于其罕见性，虽然结果不具有结论性，但感染并发症患者倾向于不接受癌症治疗。
