Zuccatosta Lina, Gonnelli Francesca, Gasparini Gianmarco, Duro Arianna, Barbisan Francesca, Goteri Gaia, Veronesi Giulia, Trisolini Rocco, Gasparini Stefano
Pulmonary Diseases Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy.
Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Region, 60126 Ancona, Italy.
Diagnostics (Basel). 2023 Jul 17;13(14):2393. doi: 10.3390/diagnostics13142393.
Echobronchoscope-guided transbronchial needle aspiration (EBUS-TBNA) is mainly used as the transbronchial approach to hilar/mediastinal lymph nodes or lesions, for diagnostic or staging purposes. Moreover, the role of linear EBUS-TBNA as a diagnostic tool for central intrapulmonary lesions adjacent to the trachea or the major bronchi is also well established. However, since the tip of the ultrasound probe at the distal end of the echobronchoscope is very thin, it can be wedged through smaller peripheral bronchi, reaching the distal parenchyma and allowing for peripheral pulmonary lesion sampling. The main aim of this retrospective study was to evaluate the diagnostic yield and the safety of EBUS-TBNA in the diagnosis of pulmonary peripheral nodules. The database of the Interventional Pulmonology Unit of Azienda Ospedaliero-Universitaria delle Marche (Ancona, Italy) was evaluated to identify peripheral pulmonary nodules approached by EBUS-TBNA. Thirty patients with a single peripheral pulmonary nodule located peripherally to the subsegmental bronchi of the lower lobes and adjacent to a small bronchus greater than 3 mm in diameter were included in this study. The nodule was visible using endoscopic ultrasound in 28 patients and the diagnosis was obtained via EBUS-TBNA in 26 cases (12 adenocarcinoma, 5 typical carcinoid tumors, 4 hamartoma and 5 metastatic lesions). The diagnostic yield was 86.6% for all 30 patients and 92.8% if only the 28 patients in which the lesion was visualized via echobronchoscopy were considered. No relevant adverse events were observed. We conclude that EBUS-TBNA may be an effective and safe option to sample pulmonary peripheral nodules in selected patients with lower lobe peripheral pulmonary lesions adjacent to small bronchi greater than 3 mm in diameter and reachable with the EBUS-TBNA probe.
超声支气管镜引导下经支气管针吸活检术（EBUS-TBNA）主要用于经支气管途径获取肺门/纵隔淋巴结或病变组织，以达到诊断或分期目的。此外，线性EBUS-TBNA作为诊断气管或主支气管旁中央型肺内病变的工具，其作用也已得到充分证实。然而，由于超声支气管镜远端的超声探头尖端非常细，它可以楔入较小的外周支气管，到达远端实质，从而实现对周围肺病变的采样。这项回顾性研究的主要目的是评估EBUS-TBNA诊断周围型肺结节的诊断率和安全性。对意大利马尔凯大区安科纳大学医院介入肺病科的数据库进行评估，以确定经EBUS-TBNA检查的周围型肺结节。本研究纳入了30例患者，这些患者的单个周围型肺结节位于下叶亚段支气管外周，且与直径大于3mm的小支气管相邻。28例患者的结节在内镜超声下可见，26例（12例腺癌、5例典型类癌肿瘤、4例错构瘤和5例转移瘤）通过EBUS-TBNA获得诊断。30例患者的总体诊断率为86.6%，若仅考虑通过超声支气管镜观察到病变的28例患者，诊断率为92.8%。未观察到相关不良事件。我们得出结论，对于部分下叶周围型肺病变患者，若病变与直径大于3mm的小支气管相邻且可通过EBUS-TBNA探头到达，EBUS-TBNA可能是一种有效且安全的周围型肺结节采样方法。
