Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clin Respir J. 2024 May;18(5):e13768. doi: 10.1111/crj.13768.
Manual navigation (MN), drawing a bronchoscopic road map simply by looking at the consecutive computed tomography (CT), is feasible and economical. However, scant data about the use of MN in radial endobronchial ultrasound (r-EBUS) bronchoscopy have been documented till now. We aimed to evaluate the diagnostic performance of r-EBUS bronchoscopy guided by MN for diagnosing peripheral pulmonary lesions (PPLs) and to determine clinical factors affecting the diagnostic yield.
We performed a retrospective, cohort study of consecutive patients with PPLs who underwent r-EBUS bronchoscopic biopsy via guidance of MN from May 2020 to June 2021 in our Respiratory Endoscopic Division. The overall diagnostic yield of MN-guided r-EBUS, the factors affecting the yield, and the diagnostic performance for malignancy were evaluated.
A total of 102 patients (103 lesions) were evaluated. The overall diagnostic yield of MN-guided r-EBUS was 82.0%, and it ranged from 79.6% to 82.5%, assuming the undermined cases were all positive cases (79.6%) or negatives (82.5%). The sensitivity of MN-guided r-EBUS for malignancy was 71.4%, ranging from 68.2% to 71.4%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 67.3%, ranging from 63.8% to 69.0%. The multivariate logistic regression showed that "bronchus sign on CT" was the only predictor of the overall diagnostic yield (odds ratio = 11.5, 95% confidence interval: 1.9-70.9, P = 0.009).
MN-guided r-EBUS is feasible in diagnosing PPLs, especially for lesions with bronchus sign on CT.
手动导航（MN）通过观察连续的计算机断层扫描（CT）来简单地绘制支气管路径图，是可行且经济的。然而，到目前为止，关于 MN 在径向支气管内超声（r-EBUS）支气管镜检查中的应用的数据很少。我们旨在评估 MN 引导的 r-EBUS 支气管镜检查对诊断周围性肺部病变（PPL）的诊断性能，并确定影响诊断率的临床因素。
我们对 2020 年 5 月至 2021 年 6 月期间在呼吸内镜科接受 MN 引导的 r-EBUS 支气管镜活检的连续 PPL 患者进行了回顾性队列研究。评估 MN 引导的 r-EBUS 的总体诊断率、影响诊断率的因素以及恶性肿瘤的诊断性能。
共评估了 102 例患者（103 个病灶）。MN 引导的 r-EBUS 的总体诊断率为 82.0%，假设未检出的病例均为阳性（79.6%）或阴性（82.5%），范围为 79.6%至 82.5%。MN 引导的 r-EBUS 对恶性肿瘤的敏感性为 71.4%，范围为 68.2%至 71.4%，特异性为 100%，阳性预测值为 100%，阴性预测值为 67.3%，范围为 63.8%至 69.0%。多变量逻辑回归显示，“CT 上的支气管征”是总体诊断率的唯一预测因素（比值比=11.5，95%置信区间：1.9-70.9，P=0.009）。
MN 引导的 r-EBUS 可用于诊断 PPL，特别是对于 CT 上有支气管征的病变。
