Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan,
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan,
Respiration. 2022;101(12):1148-1156. doi: 10.1159/000526574. Epub 2022 Nov 3.
Several factors have been reported to affect the diagnostic yield of bronchoscopy with radial endobronchial ultrasound (R-EBUS) for peripheral pulmonary lesions (PPLs). However, it is difficult to accurately predict the diagnostic potential of bronchoscopy for each PPL in advance.
Our objective was to establish a predictive model to evaluate the diagnostic yield before the procedure.
We retrospectively analysed consecutive patients who underwent diagnostic bronchoscopy with R-EBUS between April 2012 and October 2015. We assessed the factors that were predictive of successful bronchoscopic diagnosis of PPLs with R-EBUS using a multivariable logistic regression model. The accuracy of the predictive model was evaluated using the receiver operator characteristic area under the curve (ROC AUC). Internal validation was analysed using 10-fold stratified cross-validation.
We analysed a total of 1,634 lesions; the median lesion size was 25.0 mm. Of these, 1,138 lesions (69.6%) were successfully diagnosed. In the predictive logistic model, significant factors affecting the diagnostic yield were lesion size, lesion structure, bronchus sign, and visible on chest X-ray. The predictive model consisted of seven factors: lesion size, lesion lobe, lesion location from the hilum, lesion structure, bronchus sign, visibility on chest X-ray, and background lung. The ROC AUC of the predictive model was 0.742 (95% confidence interval: 0.715-0.769). Internal validation using 10-fold stratified cross-validation revealed a mean ROC AUC of 0.734.
The predictive model using the seven factors revealed a good performance in estimating the diagnostic yield.
有报道称，多种因素会影响经支气管径向超声（R-EBUS）引导下对周边肺部病变（PPL）的诊断率。然而，难以提前准确预测每个 PPL 支气管镜检查的诊断潜能。
我们旨在建立一个预测模型，以便在检查前评估诊断率。
我们回顾性分析了 2012 年 4 月至 2015 年 10 月期间接受诊断性 R-EBUS 支气管镜检查的连续患者。我们使用多变量逻辑回归模型评估了对 R-EBUS 引导下成功诊断 PPL 的预测因子。使用接收者操作特征曲线（ROC）下面积（AUC）评估预测模型的准确性。通过 10 折分层交叉验证进行内部验证分析。
我们共分析了 1634 个病灶；病灶的中位数大小为 25.0mm。其中，1138 个病灶（69.6%）成功诊断。在预测性逻辑模型中，影响诊断率的显著因素是病灶大小、病灶结构、支气管征和 X 线胸片可见性。预测模型由 7 个因素组成：病灶大小、病灶叶、病灶与肺门的距离、病灶结构、支气管征、X 线胸片可见性和背景肺。预测模型的 ROC AUC 为 0.742（95%置信区间：0.715-0.769）。使用 10 折分层交叉验证进行内部验证显示平均 ROC AUC 为 0.734。
使用这 7 个因素的预测模型在评估诊断率方面表现良好。
