Ito Takayasu, Okachi Shotaro, Kimura Tomoki, Kataoka Kensuke, Suzuki Yasuhiko, Kinoshita Fumie, Wakahara Keiko, Hashimoto Naozumi, Kondoh Yasuhiro
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 489-8642, Japan.
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan.
Cancers (Basel). 2021 Nov 17;13(22):5751. doi: 10.3390/cancers13225751.
In patients with interstitial lung disease (ILD), the most frequent locations of lung cancer are within or near fibrotic lesions. However, the diagnostic yield for peripheral pulmonary lesions (PPLs) within or near fibrotic lesions using endobronchial ultrasonography with a guide sheath transbronchial biopsy (EBUS-GS TBB) may be unsatisfactory compared to that for PPLs distant from fibrotic lesions because of the difficulty in reaching the lesions. Our objectives were to evaluate the yield for PPLs using EBUS-GS TBB according to the proximity of PPLs to fibrotic lesions and to determine factors affecting the yield for PPLs. We retrospectively investigated 323 consecutive lesions using EBUS-GS TBB between 1 November 2014 and 31 December 2016. We identified PPLs with ILD in such lesions. PPLs with ILD were divided into PPLs within or near fibrotic lesions which met the criterion of PPLs, and of fibrotic lesions overlapping each other (PPLs-FL) and those distant from fibrotic lesions, which met the criterion of PPLs and the area of fibrotic lesion not overlapping each other (PPLs-NFL). Of the 323 lesions, 55 were included (31 PPLs-FL and 24 PPLs-NFL). The diagnostic yield for PPLs-FL was significantly lower than for PPLs-NFL (45.2% vs. 83.3%, = 0.004). Multivariate analysis revealed that PPLs-NFL (odds ratio (OR) = 7.509) and a probe position within the lesion (OR = 4.172) were significant factors affecting diagnostic yield. Lesion's positional relation to fibrotic lesions and the probe position were important factors affecting the successful diagnosis via EBUS-GS TBB in these patients.
在间质性肺疾病（ILD）患者中，肺癌最常见的位置是在纤维化病灶内或其附近。然而，与远离纤维化病灶的周围肺部病变（PPL）相比，使用带引导鞘的支气管内超声引导下经支气管活检（EBUS-GS TBB）对纤维化病灶内或其附近的PPL进行诊断的阳性率可能并不理想，因为难以到达这些病灶。我们的目的是根据PPL与纤维化病灶的接近程度评估使用EBUS-GS TBB对PPL的诊断阳性率，并确定影响PPL诊断阳性率的因素。我们回顾性研究了2014年11月1日至2016年12月31日期间连续使用EBUS-GS TBB的323个病灶。我们在这些病灶中识别出伴有ILD的PPL。伴有ILD的PPL被分为符合PPL标准且位于纤维化病灶内或其附近以及纤维化病灶相互重叠的PPL（PPL-FL）和符合PPL标准且纤维化病灶区域不相互重叠且远离纤维化病灶的PPL（PPL-NFL）。在这323个病灶中，有55个被纳入研究（31个PPL-FL和24个PPL-NFL）。PPL-FL的诊断阳性率显著低于PPL-NFL（45.2%对83.3%，P = 0.004）。多因素分析显示，PPL-NFL（比值比（OR）= 7.509）和探头位于病灶内（OR = 4.172）是影响诊断阳性率的重要因素。病灶与纤维化病灶的位置关系以及探头位置是影响这些患者通过EBUS-GS TBB成功诊断的重要因素。
