Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
Expert Rev Respir Med. 2023 Jul-Dec;17(10):929-936. doi: 10.1080/17476348.2023.2278605. Epub 2023 Nov 24.
Radial probe endobronchial ultrasound (rEBUS) improves the diagnostic yield of peripheral pulmonary lesions (PPLs). A notable methodological limitation of rEBUS is that it does not provide real-time images during transbronchial biopsy (TBB) procedures. To overcome this limitation, a guide sheath (GS) method was developed.
This review covers the procedures and complications of rEBUS-guided TBB with a GS (EGS method). We also present the data from key randomized controlled trials (RCTs) of the EGS method and summarize the usefulness of combining the EGS method with various techniques. Finally, we discuss in which situations EGS should be used.
A large RCT showed that the diagnostic yield of the EGS method for PPLs was significantly higher than that of rEBUS-guided TBB without a GS (non-GS method). However, since the EGS and non-GS methods each have their own advantages and disadvantages, they should be considered complementary and used flexibly in different cases. In some cases, a combination of the two may be an option. The appropriate combination of EGS with various techniques may enhance the diagnostic yield of PPLs and help prevent complications. The choice should be based on the location and texture of the target lesion, as well as operator skill, resource availability, safety, and accuracy.
径向探头支气管内超声（rEBUS）提高了周围性肺部病变（PPL）的诊断率。rEBUS 的一个显著方法学局限性是，它在经支气管活检（TBB）过程中无法提供实时图像。为了克服这一局限性，开发了一种引导鞘（GS）方法。
本文回顾了使用 GS（EGS 方法）进行 rEBUS 引导 TBB 的程序和并发症。我们还介绍了 EGS 方法的关键随机对照试验（RCT）的数据，并总结了将 EGS 方法与各种技术相结合的有用性。最后，我们讨论了在哪些情况下应使用 EGS。
一项大型 RCT 表明，EGS 方法对 PPL 的诊断率明显高于无 GS（非 GS 方法）的 rEBUS 引导 TBB。然而，由于 EGS 和非 GS 方法各有优缺点，因此应考虑将它们互补使用，并根据不同情况灵活应用。在某些情况下，两者的组合可能是一种选择。EGS 与各种技术的适当结合可能会提高 PPL 的诊断率，并有助于预防并发症。选择应基于目标病变的位置和质地、操作者的技能、资源可用性、安全性和准确性。
