Oki Masahide, Saka Hideo, Imabayashi Tatsuya, Himeji Daisuke, Nishii Yoichi, Nakashima Harunori, Minami Daisuke, Okachi Shotaro, Mizumori Yasuyuki, Ando Masahiko
Dept of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
Dept of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
Eur Respir J. 2022 May 26;59(5). doi: 10.1183/13993003.01678-2021. Print 2022 May.
Guide sheaths (GSs) have been widely used during radial probe endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) of peripheral pulmonary lesions. However, it remains unknown whether a GS enhances the diagnostic yield. We compared the diagnostic yields of small peripheral pulmonary lesions between rEBUS-TBB with and without a GS.
In eight institutions, patients with peripheral pulmonary lesions ≤30 mm in diameter were enrolled and randomised to undergo rEBUS-TBB with a GS (GS group) or without a GS (non-GS group) using a 4.0-mm thin bronchoscope, virtual bronchoscopic navigation and fluoroscopy. The primary end-point was the diagnostic yield of the histology specimens.
A total of 605 patients were enrolled; ultimately, data on 596 (300 in the GS group and 296 in the non-GS group) with peripheral pulmonary lesions having a longest median diameter of 19.6 mm were analysed. The diagnostic yield of histological specimens from the GS group was significantly higher than that from the non-GS group (55.3% 46.6%; p=0.033). Interactions were evident between the diagnostic yields, procedures, lobar locations (upper lobe other regions; p=0.003) and lesion texture (solid part-solid nodules; p=0.072).
The diagnostic yield for small peripheral pulmonary lesions afforded by rEBUS-TBB using a GS was higher than that without a GS.
在经桡骨探头支气管内超声引导下经支气管活检（rEBUS-TBB）外周肺病变过程中，引导鞘（GS）已被广泛应用。然而，GS是否能提高诊断率仍不清楚。我们比较了使用和不使用GS进行rEBUS-TBB时外周小肺病变的诊断率。
在8家机构中，纳入直径≤30 mm的外周肺病变患者，并随机分组，使用4.0 mm细支气管镜、虚拟支气管镜导航和荧光透视，一组接受带GS的rEBUS-TBB（GS组），另一组接受不带GS的rEBUS-TBB（非GS组）。主要终点是组织学标本的诊断率。
共纳入605例患者；最终，分析了596例（GS组300例，非GS组296例）外周肺病变患者的数据，这些病变的最长中位直径为19.6 mm。GS组组织学标本的诊断率显著高于非GS组（55.3%对46.6%；p=0.033）。诊断率、操作、叶位置（上叶对其他区域；p=0.003）和病变质地（实性对部分实性结节；p=0.072）之间存在明显的相互作用。
使用GS进行rEBUS-TBB对外周小肺病变的诊断率高于不使用GS时。
