Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea.
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241273017. doi: 10.1177/17534666241273017.
Radial probe endobronchial ultrasound (radial EBUS) is widely used to diagnose pulmonary lesions; however, the diagnostic value of radial EBUS-guided transbronchial biopsy (TBB) varies, and its complications (especially the risk of bleeding) are not properly understood.
In this study, we evaluated the diagnostic performance and rate of complication of this procedure, and investigated the risk factors associated with the procedure-related bleeding events.
A retrospective cohort study.
This was a retrospective study that included consecutive patients who underwent radial EBUS-guided TBB. Radial EBUS was performed under moderate sedation in inpatients or outpatients. The severity of bleeding was graded using the standardized definitions of bleeding.
Of 133 patients (median age, 69 years; men 57.1%) included, 41 were outpatients (30.8%). The diagnostic accuracy, sensitivity, and specificity for malignancy were 76.1% (89/117), 71.1% (69/97), and 100% (20/20), respectively. The diagnostic accuracy ranged from 66.9% to 79.0%, depending on the classification of undiagnosed cases as either false negatives or true negatives. Twenty-seven patients (20.3%) developed complications (pneumothorax, 3; pneumonia, 5; complicated pleural effusion, 2; bleeding event grade 2 or higher, 21). Of the 41 outpatients, two developed complications (pneumothorax without intervention, 1; grade 2 bleeding event, 1). Of the 21 patients (15.8%) with procedure-related bleeding events, 18 had grade 2, and three had grade 3 bleeding complications. In multivariate analysis, a large size of ⩾30 mm (adjusted odds ratio (OR), 5.09; = 0.03) and central lesion (adjusted OR, 3.67; = 0.03) were significantly associated with the risk of grade 2 or higher bleeding events.
Our results suggest that radial EBUS-guided TBB is an accurate and safe method for diagnosing pulmonary lesions. Clinically significant procedure-related bleeding was rare. The central location and larger size (⩾30 mm) of pulmonary lesions were risk factors for grade 2 or higher bleeding events.
径向探头支气管内超声（radial EBUS）广泛用于诊断肺部病变；然而，径向 EBUS 引导下经支气管活检（TBB）的诊断价值存在差异，其并发症（特别是出血风险）尚未得到充分认识。
本研究评估了该操作的诊断性能和并发症发生率，并探讨了与操作相关出血事件相关的危险因素。
回顾性队列研究。
这是一项回顾性研究，纳入了接受径向 EBUS 引导下 TBB 的连续患者。在住院或门诊患者中，在中度镇静下进行径向 EBUS。使用出血的标准化定义来分级出血的严重程度。
共纳入 133 例患者（中位年龄 69 岁；男性占 57.1%），其中 41 例为门诊患者（30.8%）。恶性肿瘤的诊断准确性、敏感性和特异性分别为 76.1%（89/117）、71.1%（69/97）和 100%（20/20）。根据将未确诊病例归类为假阴性或真阴性，诊断准确性范围为 66.9%至 79.0%。27 例（20.3%）发生并发症（气胸 3 例；肺炎 5 例；复杂胸腔积液 2 例；2 级或更高等级的出血事件 21 例）。在 41 例门诊患者中，有 2 例发生并发症（无需干预的气胸 1 例；2 级出血事件 1 例）。在 21 例（15.8%）与操作相关的出血事件中，18 例为 2 级，3 例为 3 级出血并发症。多变量分析显示，病灶大小≥30mm（调整后的优势比（OR）5.09； = 0.03）和中央病灶（调整后的 OR 3.67； = 0.03）与 2 级或更高等级出血事件的风险显著相关。
我们的结果表明，径向 EBUS 引导下 TBB 是一种准确且安全的诊断肺部病变的方法。与操作相关的临床显著出血罕见。肺部病变的中央位置和较大（≥30mm）大小是 2 级或更高等级出血事件的危险因素。
