Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan,
Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan,
Respiration. 2023;102(2):143-153. doi: 10.1159/000528644. Epub 2022 Dec 21.
Endobronchial ultrasound (EBUS)-guided intranodal forceps biopsy (IFB), a diagnostic bronchoscopic technique for intrathoracic lymphadenopathy, is performed following EBUS-guided transbronchial needle aspiration (TBNA). The current EBUS-IFB technique is complex and provides small sample volumes. We modified this technique to allow the use of standard-sized forceps.
The aim of this study was to assess the feasibility of the modified EBUS-IFB technique, which combines standard-sized forceps with standard EBUS-TBNA equipment.
This retrospective analysis included consecutive patients scheduled for EBUS-TBNA with attempted additional IFB between July 2020 and March 2021. The feasibility indices of IFB, technical success rate, diagnostic accuracy, and major complications were retrospectively investigated. We performed semi-quantitative evaluation of the histological specimens and univariable analyses to identify factors associated with IFB failure.
During the study period, 295 patients underwent 307 EBUS-TBNAs; 195 cases were included in the analyses. Target lesions were mainly mediastinal lymph nodes (134 cases, 68.7%); the most frequent sites were #7 (61 cases) and #4R (50 cases). The median lesion size was 16.1 mm, the technical IFB success rate was 90.8%, and the diagnostic accuracy of the TBNA and IFB combination was 99.5%. One patient was lost to follow-up. Univariable analyses did not identify any factors involved in technical IFB failure. Major complications of pneumonia and pneumothorax occurred in 2 cases (1.0%). The median histological score was significantly higher in the IFB group than in the TBNA group (1.67 vs. 1.50, p = 0.032).
Modified EBUS-IFB, combining standard-sized forceps with common EBUS-TBNA equipment, is feasible with few major complications.
经支气管超声引导（EBUS）引导下的腔内活检（IFB）是一种用于诊断胸腔内淋巴结病的支气管镜诊断技术，在 EBUS 引导下经支气管针吸活检（TBNA）之后进行。目前的 EBUS-IFB 技术较为复杂，且提供的样本量较小。我们对该技术进行了改良，使其可以使用标准大小的活检钳。
本研究旨在评估改良后的 EBUS-IFB 技术的可行性，该技术将标准大小的活检钳与标准的 EBUS-TBNA 设备相结合。
本回顾性分析纳入了 2020 年 7 月至 2021 年 3 月期间连续进行 EBUS-TBNA 并尝试额外进行 IFB 的患者。回顾性调查 IFB 的可行性指数、技术成功率、诊断准确性和主要并发症。我们对组织学标本进行半定量评估，并进行单变量分析，以确定与 IFB 失败相关的因素。
在研究期间，共 295 例患者进行了 307 次 EBUS-TBNA，其中 195 例纳入分析。目标病变主要为纵隔淋巴结（134 例，68.7%），最常见的部位是#7（61 例）和#4R（50 例）。病变大小中位数为 16.1mm，技术 IFB 成功率为 90.8%，TBNA 和 IFB 联合的诊断准确性为 99.5%。1 例患者失访。单变量分析未发现任何与技术 IFB 失败相关的因素。肺炎和气胸等主要并发症发生于 2 例患者（1.0%）。IFB 组的组织学评分中位数明显高于 TBNA 组（1.67 比 1.50，p=0.032）。
改良后的 EBUS-IFB 将标准大小的活检钳与常见的 EBUS-TBNA 设备相结合，具有可行性，且主要并发症较少。
