Hu Zhenli, Tian Sen, Wang Xiangqi, Wang Qin, Gao Li, Shi Yuxuan, Li Xiang, Tang Yilian, Zhang Wei, Dong Yuchao, Bai Chong, Huang Haidong
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China.
Front Oncol. 2023 Jul 31;13:1168870. doi: 10.3389/fonc.2023.1168870. eCollection 2023.
Transbronchial lung biopsy guided by radial probe endobronchial ultrasonography with a guide sheath (EBUS-GS-TBLB) is becoming a significant approach for diagnosing peripheral pulmonary lesions (PPLs). We aimed to explore the clinical value of the resistance of the probe to pass through the lesion in the diagnosis of PPLs when performing EBUS-GS-TBLB, and to determine the optimum number of EBUS-GS-TBLB.
We performed a prospective, single-center study of 126 consecutive patients who underwent EBUS-GS-TBLB for solid and positive-bronchus-sign PPLs where the probe was located within the lesion from September 2019 to May 2022. The classification of probe resistance for each lesion was carried out by two bronchoscopists independently, and the final result depended on the bronchoscopist responsible for the procedures. The primary endpoint was the diagnostic yield according with the resistance pattern. The secondary endpoints were the optimum number of EBUS-GS-TBLB and factors affecting diagnostic yield. Procedural complications were also recorded.
The total diagnostic yield of EBUS-GS-TBLB was 77.8%, including 83.8% malignant and 67.4% benign diseases (P=0.033). Probe resistance type II displayed the highest diagnostic yield (87.5%), followed by type III (81.0%) and type I (61.1%). A significant difference between the diagnostic yield of malignant and benign diseases was detected in type II (P = 0.008), whereas others did not. Although most of the malignant PPLs with a definitive diagnosis using EBUS-GS-TBLB in type II or type III could be diagnosed in the first biopsy, the fourth biopsy contributed the most sufficient biopsy samples. In contrast, considerably limited tissue specimens could be obtained for each biopsy in type I. The inter-observer agreement of the two blinded bronchoscopists for the classification of probe resistance was excellent (κ = 0.84).
The probe resistance is a useful predictive factor for successful EBUS-GS-TBLB diagnosis of solid and positive-bronchus-sign PPLs where the probe was located within the lesion. Four serial biopsies are appropriate for both probe resistance type II and type III, and additional diagnostic procedures are needed for type I.
使用带引导鞘的径向探头支气管内超声引导下经支气管肺活检（EBUS-GS-TBLB）正成为诊断周围型肺病变（PPL）的重要方法。我们旨在探讨在进行EBUS-GS-TBLB时，探头穿过病变的阻力在PPL诊断中的临床价值，并确定EBUS-GS-TBLB的最佳活检次数。
我们对2019年9月至2022年5月期间连续126例因实性及支气管征阳性的PPL而接受EBUS-GS-TBLB且探头位于病变内的患者进行了一项前瞻性单中心研究。两名支气管镜检查医师独立对每个病变的探头阻力进行分类，最终结果取决于负责操作的支气管镜检查医师。主要终点是根据阻力模式的诊断阳性率。次要终点是EBUS-GS-TBLB的最佳活检次数及影响诊断阳性率的因素。还记录了操作并发症。
EBUS-GS-TBLB的总诊断阳性率为77.8%，其中恶性疾病诊断阳性率为83.8%，良性疾病为67.4%（P=0.033）。探头阻力II型的诊断阳性率最高（87.5%），其次是III型（81.0%）和I型（61.1%）。II型中恶性和良性疾病的诊断阳性率存在显著差异（P = 0.008），而其他类型则没有。尽管大多数在II型或III型中通过EBUS-GS-TBLB明确诊断的恶性PPL在首次活检时即可诊断，但第四次活检获得的活检样本最为充足。相比之下，I型中每次活检可获得的组织标本相当有限。两名盲法支气管镜检查医师对探头阻力分类的观察者间一致性良好（κ = 0.84）。
对于探头位于病变内的实性及支气管征阳性的PPL，探头阻力是EBUS-GS-TBLB诊断成功的有用预测因素。对于探头阻力II型和III型，连续进行四次活检是合适的，而I型则需要额外的诊断程序。
