Lachkar Samy, Salaün Mathieu, Perrot Loic, Gervereau Diane, De Marchi Marielle, Le Bouar Gurvan, Morisse-Pradier Helene, Dominique Stephane, Piton Nicolas, Guisier Florian, Thiberville Luc
Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC-CRB 1404, Rouen University Hospital, F-76000 Rouen, France.
EA4108 LITIS Lab, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, Normandie Univ, F-76000 Rouen, France.
J Clin Med. 2021 Dec 25;11(1):104. doi: 10.3390/jcm11010104.
The diagnosis of organizing pneumonia (OP) often requires histological confirmation. The aim of this retrospective study was to evaluate the diagnostic yield and complication rate of radial endobronchial ultrasound (r-EBUS) for OP.
All patients who had r-EBUS as a first diagnostic procedure for a peripheral pulmonary lesion at Rouen University Hospital, France, between April 2008 and December 2020 were included. Cases without a final diagnosis of OP or follow-up were excluded. Patients, lesions, and r-EBUS characteristics were retrospectively analyzed.
2735 r-EBUS procedures were performed, and 33 cases with final OP could be analyzed. Procedures were performed under local anesthesia in 28/33 cases (85%). Among the 33 final OP cases, 17 were considered cryptogenic, and 16 secondary. The lesions were patchy alveolar opacities in 23 cases (70%), masses or pulmonary nodules in 8 cases (24%), and diffuse infiltrative opacities in 2 cases (6%). A bronchus sign on CT scan was found in all cases. In 22 cases (67%), a histopathological diagnosis was obtained from the r-EBUS samples. In 4 cases (12%), histopathological diagnosis was made by surgery, and in 7 cases (21%) the diagnosis was made based on clinical, radiological, and evolution features. An ultrasound image was found in 100% (22/22) of cases in the r-EBUS positive (r-EBUS+) group vs. 60% (6/10) in the r-EBUS negative (r-EBUS-) group, respectively ( < 0.002). The diagnostic yield of r-EBUS for OP was 67% and increased to 79% (22/28) when an ultrasound image was obtained. The median time between CT scan and r-EBUS procedure was 14 days (3-94): 11.5 days in the r-EBUS+ group and 22 days in the r-EBUS- group ( < 0.0001). No severe complications were reported.
r-EBUS, when performed shortly after a CT scan showing a bronchus sign, is an efficient and safe technique for OP diagnosis.
机化性肺炎（OP）的诊断通常需要组织学证实。这项回顾性研究的目的是评估径向支气管内超声（r-EBUS）对OP的诊断率和并发症发生率。
纳入2008年4月至2020年12月期间在法国鲁昂大学医院接受r-EBUS作为外周肺部病变首次诊断程序的所有患者。排除未最终诊断为OP或未进行随访的病例。对患者、病变和r-EBUS特征进行回顾性分析。
共进行了2735例r-EBUS检查，其中33例最终诊断为OP的病例可供分析。33例中有28例（85%）在局部麻醉下进行检查。在33例最终诊断为OP的病例中，17例被认为是隐源性的，16例是继发性的。病变表现为斑片状肺泡实变23例（70%），肿块或肺结节8例（24%），弥漫性浸润性实变2例（6%）。所有病例CT扫描均发现支气管征。22例（67%）通过r-EBUS样本获得组织病理学诊断。4例（12%）通过手术获得组织病理学诊断，7例（21%）根据临床、影像学和病情演变特征做出诊断。r-EBUS阳性（r-EBUS+）组100%（22/22）的病例发现超声图像，而r-EBUS阴性（r-EBUS-）组为60%（6/10）（P<0.002）。r-EBUS对OP的诊断率为67%，当获得超声图像时，诊断率提高到79%（22/28）。CT扫描与r-EBUS检查之间的中位时间为14天（3-94天）：r-EBUS+组为11.5天，r-EBUS-组为22天（P<0.0001）。未报告严重并发症。
在CT扫描显示支气管征后不久进行r-EBUS检查是诊断OP的一种有效且安全的技术。
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