Ankudavicius Vytautas, Miliauskas Skaidrius, Poskiene Lina, Vajauskas Donatas, Zemaitis Marius
Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Department of Pathology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Cancers (Basel). 2022 Mar 18;14(6):1563. doi: 10.3390/cancers14061563.
Transbronchial cryobiopsy (TBCB) is being studied in the diagnosis of peripheral lung lesions; however, there are only a few clinical studies around the world. The aim of our study was to evaluate the diagnostic values and safety of transbronchial cryobiopsy for radiologically suspected peripheral lung cancer. The prospective clinical study was executed from September 2019 to September 2021 at a tertiary clinical centre in Lithuania. A total of 48 patients out of 102 underwent combined procedures of transbronchial forceps biopsy (TBFB) and TBCB. Diagnostic values and safety outcomes of TBFB and TBCB were analysed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 72.9%, 100%, 100%, 7.7%, and 88.0% for TBFB, 85.1%, 100%, 100%, 12.5%, and 93% for TBCB, as well as 91.5%, 100%, 100%, 20.0% and 96.7% for the combined procedures, respectively, with a significantly higher accuracy for cryobiopsies compared to forceps biopsies (p < 0.05). The diagnostic values for transbronchial cryobiopsies were similar, irrespective of the radial mini probe endobronchial ultrasound (RP-EBUS) position, lesion size or bronchus sign, however, the sensitivity of the combined procedures in cases with RP-EBUS adjacent to the target was significantly higher compared to TBFB (86.2% vs. 64.3%, p = 0.016). Samples of cryobiopsies were significantly larger than forceps biopsies (34.62 mm2 vs. 4.4 mm2, p = 0.001). The cumulative diagnostic yield of transbronchial cryobiopsy was 80.0% after the second biopsy and reached a plateau of 84.1% after four biopsies. No severe bleeding, pneumothorax, respiratory failure or death was registered in our study. TBCB is a potentially safe procedure, which increases diagnostic values in diagnosing peripheral lung lesions compared to TBFB.
经支气管冷冻活检(TBCB)正在用于外周肺病变的诊断研究;然而,全球范围内的临床研究仅有少数。我们研究的目的是评估经支气管冷冻活检对于放射学怀疑的外周肺癌的诊断价值和安全性。这项前瞻性临床研究于2019年9月至2021年9月在立陶宛的一家三级临床中心开展。102例患者中有48例接受了经支气管钳夹活检(TBFB)和TBCB的联合操作。分析了TBFB和TBCB的诊断价值和安全性结果。TBFB的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性分别为72.9%、100%、100%、7.7%和88.0%,TBCB分别为85.1%、100%、100%、12.5%和93%,联合操作分别为91.5%、100%、100%、20.0%和96.7%,与钳夹活检相比,冷冻活检的准确性显著更高(p < 0.05)。无论径向微型探头支气管内超声(RP-EBUS)位置、病变大小或支气管征如何,经支气管冷冻活检的诊断价值相似,然而,在RP-EBUS靠近靶病变的病例中,联合操作的敏感性显著高于TBFB(86.2%对64.3%,p = 0.016)。冷冻活检的样本显著大于钳夹活检(34.62平方毫米对4.4平方毫米,p = 0.001)。经支气管冷冻活检在第二次活检后的累积诊断率为80.0%,在四次活检后达到84.1%的平台期。我们研究中未记录到严重出血、气胸、呼吸衰竭或死亡。TBCB是一种潜在安全的操作,与TBFB相比,其在诊断外周肺病变时可提高诊断价值。
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