Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Lung Cancer. 2023 Jul;181:107234. doi: 10.1016/j.lungcan.2023.107234. Epub 2023 May 8.
Electromagnetic navigation bronchoscopy (ENB) is an advanced technique for diagnosing peripheral pulmonary lesions, and the bronchus sign is a well-established factor for improving the diagnostic performance. However, ENB is a novel technology compared to the commonly adopted transthoracic needle biopsy (TTNB). There are limited data on the comparison of these techniques for diagnosing bronchus sign-positive lesions. Therefore, we aimed to compare the diagnostic yield and complication rates of ENB and TTNB for diagnosing lung cancer in bronchus sign-positive pulmonary lesions.
We assessed 2,258 individuals who underwent either of the techniques for initial biopsy between September 2016 and May 2022 at a tertiary center in South Korea and analyzed 1,248 participants (153 ENB and 1,095 TTNB cases) with a positive bronchus sign. We performed multivariable logistic regression analyses to evaluate the factors associated with the diagnostic yield, sensitivity for malignancy, and procedure-related complications. In addition, the outcomes were compared between the two techniques after a 1:2 propensity score-matching to control for pre-procedural factors.
After adjustments for clinical/radiological factors, performing TTNB over ENB was not significantly associated with a higher diagnostic yield but with a higher risk of pneumothorax (OR = 9.69, 95% CI = 4.15-22.59). Propensity score-matching resulted in 459 participants (153 ENB and 306 TTNB cases) with balanced pre-procedural characteristics. The overall diagnostic yield did not differ significantly between ENB and TTNB (85.0% vs. 89.9%, p = 0.124). The diagnostic yield (86.7% vs. 90.3%, p = 0.280) and sensitivity for malignancy (85.3% vs. 88.8%, p = 0.361) were comparable among patients with a class 2 bronchus sign. However, TTNB demonstrated a significantly higher complication rate of pneumothorax (28.8% vs. 3.9%, p < 0.001) and pneumothorax requiring tube drainage (6.5% vs. 2.0%, p = 0.034) than ENB.
ENB demonstrated a diagnostic yield comparable with that of TTNB for diagnosing bronchus sign-positive peripheral pulmonary lesions with significantly lower complication rates.
电磁导航支气管镜（ENB）是一种诊断周围性肺病变的先进技术，支气管征是提高诊断性能的一个既定因素。然而，与常用的经胸针吸活检（TTNB）相比，ENB 是一种新技术。关于这两种技术在诊断支气管征阳性病变方面的比较，数据有限。因此，我们旨在比较 ENB 和 TTNB 诊断支气管征阳性肺部病变中肺癌的诊断率和并发症发生率。
我们评估了 2016 年 9 月至 2022 年 5 月期间在韩国一家三级中心接受这两种技术之一进行初始活检的 2258 人，并对 1248 名支气管征阳性患者（153 例 ENB 和 1095 例 TTNB 病例）进行了分析。我们进行了多变量逻辑回归分析，以评估与诊断率、恶性肿瘤的敏感性和与手术相关的并发症相关的因素。此外，在进行 1:2 倾向评分匹配以控制术前因素后，比较了两种技术的结果。
在调整了临床/影像学因素后，与 ENB 相比，TTNB 进行手术与更高的诊断率无关，但与气胸的风险更高相关（OR=9.69，95%CI=4.15-22.59）。倾向评分匹配产生了 459 名参与者（153 例 ENB 和 306 例 TTNB 病例），具有平衡的术前特征。ENB 和 TTNB 的总体诊断率无显著差异（85.0% vs. 89.9%，p=0.124）。在 2 级支气管征患者中，诊断率（86.7% vs. 90.3%，p=0.280）和恶性肿瘤的敏感性（85.3% vs. 88.8%，p=0.361）相当。然而，TTNB 的气胸（28.8% vs. 3.9%，p<0.001）和需要置管引流的气胸（6.5% vs. 2.0%，p=0.034）的并发症发生率明显高于 ENB。
ENB 诊断支气管征阳性周围性肺病变的诊断率与 TTNB 相当，但并发症发生率明显较低。
