Imabayashi Tatsuya, Matsumoto Yuji, Uchimura Keigo, Furuse Hideaki, Tsuchida Takaaki
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Diagnostics (Basel). 2023 Mar 10;13(6):1064. doi: 10.3390/diagnostics13061064.
The presence of computed tomography bronchus sign (CT-BS) substantially increases the diagnostic yield of peripheral pulmonary lesions. However, the clinical significance of subdividing CT-BS remains controversial. We classified bronchus types on CT into six subtypes (CT-BS group I: types Ia-Ic with the bronchus connected within the lesion, group II: types IIa-IIc without connection) to clarify the differences in their characteristics and investigate the factors associated with diagnosis during radial endobronchial ultrasound (rEBUS)-guided bronchoscopy. In total, 1021 cases were analyzed. Our findings in diagnostic yields were that in CT-BS group I, penetrating type Ic was inferior to obstructed type Ia and narrowing type Ib (59.0% vs. 80.0% and 76.3%, < 0.001, = 0.004); in CT-BS group II, compressed type IIa showed no difference when compared with invisible type IIb and uninvolved type IIc (IIa: 52.8% vs. IIb: 46.3% and IIc: 35.7%, = 0.253). Multivariable analysis revealed that bronchus type (types Ia and Ib vs. Ic) was a significant independent predictor of successful diagnosis in CT-BS group I (odds ratio, 1.78; 95% confidence interval, 1.04-3.05; = 0.035), along with known factors such as rEBUS visualization. CT-BS subclassification may provide useful information regarding the bronchoscopic technique to facilitate accurate diagnosis.
计算机断层扫描支气管征（CT-BS）的存在显著提高了周围型肺部病变的诊断率。然而，对CT-BS进行细分的临床意义仍存在争议。我们将CT上的支气管类型分为六个亚型（CT-BS I组：Ia-Ic型，支气管在病变内相连；II组：IIa-IIc型，支气管不相连），以明确它们特征上的差异，并研究在径向支气管内超声（rEBUS）引导下支气管镜检查中与诊断相关的因素。总共分析了1021例病例。我们在诊断率方面的研究结果是，在CT-BS I组中，穿透性Ic型低于阻塞性Ia型和狭窄性Ib型（59.0%对80.0%和76.3%，<0.001，=0.004）；在CT-BS II组中，受压IIa型与不可见IIb型和未累及IIc型相比无差异（IIa：52.8%对IIb：46.3%和IIc：35.7%，=0.253）。多变量分析显示，支气管类型（Ia型和Ib型对Ic型）是CT-BS I组成功诊断的显著独立预测因素（比值比，1.78；95%置信区间，1.04-3.05；=0.035），与rEBUS可视化等已知因素一起。CT-BS亚分类可能为支气管镜技术提供有用信息，以促进准确诊断。
