Li M Y, Chen Q X, Lu Y J, Pan W Y, Zeng D X, Jiang J H
Department of Pulmonary and Critical Care Medicine, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 212151, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2024 Apr 12;47(4):332-338. doi: 10.3760/cma.j.cn112147-20231015-00234.
To assess and compare the diagnostic efficacy of next-generation ultrathin bronchoscopy (UTB) and conventional bronchoscopy (CB), both combined with radial endobronchial ultrasound (r-EBUS), in the evaluation of peripheral pulmonary lesions (PPL). A cohort of 39 patients with PPL who underwent multimodal bronchoscopy at Dushu Lake Hospital, Soochow University, from June 1, 2021 to May 31, 2023 was consecutively enrolled. A single bronchoscopist performed multimodal bronchoscopies using CB (external diameter 4.9 mm or 5.9 mm, working channel diameter 2 or 3 mm, CB group) for transbronchial biopsy under r-EBUS guidance (rEBUS-TBLB), followed by UTB (external diameter 3 mm, working channel diameter 1.7 mm, UTB group) for transbronchial biopsy under r-EBUS guidance. Pathological findings and a 6-month clinical follow-up were used as the gold standard to compare the diagnostic yield of biopsy specimens, ultrasound characteristics, and localization rates of the two bronchoscope types. The aim was to evaluate the clinical application value of UTB combined with r-EBUS. Binary variables were analysed using the McNemar test for paired data. Continuous variables or ranked data were analysed using the Wilcoxon signed-rank test for paired data. The diagnostic yields for UTB and CB groups were 66.67% (26/39) and 30.77% (12/39), respectively, with the UTB group significantly surpassing the CB group (=10.56, =0.001, 1-β=0.968). r-EBUS with CB exhibited no visible lesion in 13 cases, adjacent to the lesion in 19 cases, and within the lesion in 7 cases.Substitution of UTB resulted in r-EBUS images changing from no visible lesion to adjacent to the lesion in 7 cases, from no visible lesion to within the lesion in 3 cases, and from adjacent to the lesion to within the lesion in 12 cases. The positioning of the r-EBUS probe in relation to the lesions improved significantly with UTB usage (=-4.46, <0.001). Localization rates (number of patients with "within" or "adjacent to" the image/total number of patients) for UTB and CB were 92.30% (36/39) and 66.67% (26/39), respectively (=8.10, =0.002). UTB improved r-EBUS probe localization rates. The diagnostic yields of UTB were higher than CB for solid lesions, lesions>30 mm in diameter, non-upper lobar location, benign or malignant lesions and lesions with or without a bronchus sign. The UTB group demonstrated a significantly higher diagnostic yield than the CB group, providing superior r-EBUS probe images, and a significant diagnostic advantage for PPL.
为评估和比较新一代超薄支气管镜（UTB）和传统支气管镜（CB）联合径向支气管内超声（r-EBUS）在评估周围型肺病变（PPL）中的诊断效能。连续纳入了2021年6月1日至2023年5月31日在苏州大学独墅湖医院接受多模态支气管镜检查的39例PPL患者。由一名支气管镜检查医生使用CB（外径4.9mm或5.9mm，工作通道直径2或3mm，CB组）在r-EBUS引导下进行经支气管活检（rEBUS-TBLB），随后使用UTB（外径3mm，工作通道直径1.7mm，UTB组）在r-EBUS引导下进行经支气管活检。以病理结果和6个月的临床随访作为金标准，比较两种支气管镜活检标本的诊断率、超声特征和定位率。目的是评估UTB联合r-EBUS的临床应用价值。使用McNemar检验对配对数据的二元变量进行分析。使用Wilcoxon符号秩检验对配对数据的连续变量或等级数据进行分析。UTB组和CB组的诊断率分别为66.67%（26/39）和30.77%（12/39），UTB组显著超过CB组（=10.56，=0.001，1-β=0.968）。CB联合r-EBUS检查时，13例未见明显病变，19例病变邻近，7例病变内。改用UTB后，r-EBUS图像从未见明显病变变为病变邻近的有7例，从未见明显病变变为病变内的有3例，从病变邻近变为病变内的有12例。使用UTB后，r-EBUS探头相对于病变的定位有显著改善（=-4.46，<0.001）。UTB和CB的定位率（图像显示“病变内”或“病变邻近”的患者数/患者总数）分别为92.30%（36/39）和66.67%（26/39）（=8.10，=0.002）。UTB提高了r-EBUS探头的定位率。对于实性病变、直径>30mm的病变、非上叶部位病变、良性或恶性病变以及有或无支气管征的病变，UTB的诊断率高于CB。UTB组的诊断率显著高于CB组，提供了更好的r-EBUS探头图像，对PPL具有显著的诊断优势。
