Furuse Hideaki, Matsumoto Yuji, Nakai Toshiyuki, Tanaka Midori, Nishimatsu Kanako, Uchimura Keigo, Imabayashi Tatsuya, Tsuchida Takaaki, Ohe Yuichiro
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Lung Cancer. 2023 Apr;178:220-228. doi: 10.1016/j.lungcan.2023.02.022. Epub 2023 Mar 1.
Recently introduced cryobiopsy can provide quantitatively and qualitatively excellent specimens. However, few studies have directly compared the diagnostic yield of cryobiopsy for peripheral pulmonary lesions (PPLs) with that of conventional sampling methods.
We retrospectively reviewed data from consecutive patients who underwent diagnostic bronchoscopy using radial endobronchial ultrasound and virtual bronchoscopic navigation for PPLs (October 2015 to September 2020). Patients who underwent cryobiopsy were assigned to the cryo group, whereas those who did not undergo cryobiopsy were assigned to the conventional group. The diagnostic outcomes of both groups were compared using propensity score analyses.
A total of 2,724 cases were identified, including 492 and 2,232 cases in the cryo and conventional groups, respectively. Propensity scoring was performed to match baseline characteristics, and 481 pairs of cases were selected for each matched group (m-group). The diagnostic yield was significantly higher in the m-cryo group than in the m-conventional group (89.2% vs. 77.6%, odds ratio [OR] = 2.36 [95% confidence interval [CI] = 1.65-3.38], P < 0.001). Propensity score stratification (OR = 2.35 [95% CI = 1.71-3.23]) and regression adjustment (OR = 2.54 [95% CI = 1.83-3.52]) also demonstrated the diagnostic advantages of cryobiopsy. The subgroup analysis revealed that cryobiopsy was notably effective for lesions in the middle lobe/lingula, right/left lower lobe, lesions with ground-glass opacity, and lesions invisible on chest radiography. Although there were more cases of grade 2 and 3 bleeding in the m-cryo group than in the m-conventional group (38.0% vs. 10.2% and 1.5% vs. 0.8%, respectively; P < 0.001), no grade 4 bleeding was observed.
The propensity score analyses revealed that cryobiopsy was associated with a higher diagnostic yield for PPLs than conventional sampling methods. However, increased bleeding risk should be noted as a potential complication.
最近引入的冷冻活检可提供质量和数量上均优异的标本。然而，很少有研究直接比较冷冻活检对周围型肺病变（PPL）的诊断率与传统采样方法的诊断率。
我们回顾性分析了连续接受经支气管镜径向超声和虚拟支气管镜导航诊断性支气管镜检查的PPL患者（2015年10月至2020年9月）的数据。接受冷冻活检的患者被分配到冷冻组，而未接受冷冻活检的患者被分配到传统组。使用倾向评分分析比较两组的诊断结果。
共识别出2724例病例，冷冻组和传统组分别有492例和2232例。进行倾向评分以匹配基线特征，为每个匹配组（m组）选择了481对病例。m冷冻组的诊断率显著高于m传统组（89.2%对77.6%，优势比[OR]=2.36[95%置信区间[CI]=1.65-3.38]，P<0.001）。倾向评分分层（OR=2.35[95%CI=1.71-3.23]）和回归调整（OR=2.54[95%CI=1.83-3.52]）也显示了冷冻活检的诊断优势。亚组分析显示，冷冻活检对中叶/舌叶、右/左下叶病变、磨玻璃影病变以及胸部X线片上不可见的病变特别有效。尽管m冷冻组2级和3级出血的病例比m传统组多（分别为38.0%对10.2%和1.5%对0.8%；P<0.001），但未观察到4级出血。
倾向评分分析显示，与传统采样方法相比，冷冻活检对PPL的诊断率更高。然而，应注意出血风险增加是一种潜在并发症。
