Department of Radiology, Chest Medical District of Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, China.
Department of Respiratory Medicine, Chest Medical District of Nanjing Brain Hospital, Nanjing Medical University, 215 Guangzhou Road, Nanjing, 210029, China.
BMC Pulm Med. 2024 Aug 20;24(1):401. doi: 10.1186/s12890-024-03208-1.
This is a retrospective cohort study from a single center of Chest Medical District of Nanjing Brain Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China. It was aim to evaluate the diagnostic value of radial endobronchial ultrasound (R-EBUS) combination with rapid on-site evaluation (ROSE) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions in patients with emphysema.
All 170 patients who underwent PPLs with emphysema received an R-EBUS examination with or without the ROSE procedure, and the diagnostic yield, safety, and possible factors influencing diagnosis were analyzed between the two groups by the SPSS 25.0 software.
The pooled and benign diagnostic yields were not different in the two groups (P = 0.224, 0.924), but the diagnostic yield of malignant PPLs was significantly higher in the group with ROSE than the group without ROSE (P = 0.042). The sensitivity of ROSE was 79.10%, the specificity, 91.67%, the positive predictive value, 98.15%, and the negative predictive value, 84.62%. The diagnostic accuracy, was 95.52%. In the group of R-EBUS + ROSE, the procedural time and the number of times of biopsy or brushing were both significantly reduced (all P<0.05). The incidence of pneumothorax (1.20%) and bleeding (10.84%) in the group of R-EBUS + ROSE were also less than those in the group of R-EBUS (P<0.05). The lesion's diameter ≥ 2 cm, the distance between the pleura and the lesion ≥ 2 cm, the positive air bronchograms sign, the location of the ultrasound probe within the lesion, and the even echo with clear margin feature of lesion ultrasonic image, these factors are possibly relevant to a higher diagnostic yield. The diagnostic yield of PPLs those were adjacent to emphysema were lower than those PPLs which were away from emphysema (P = 0.048) in the group without ROSE, however, in the group of R-EBUS + ROSE, there was no such difference whether the lesion is adjacent to emphysema or not (P = 0.236).
Our study found that the combination of R-EBUS and ROSE during bronchoscopy procedure was a safe and effective modality to improve diagnostic yield of PPLs with emphysema, especially for malignant PPLs. The distance between the pleura and the lesion ≥ 2 cm, the positive air bronchograms sign, the location of the ultrasound probe within the lesion, and the even echo with clear margin feature of lesion ultrasonic image, these factors possibly indicated a higher diagnostic yield. Those lesions' position is adjacent to emphysema may reduce diagnostic yield but ROSE may make up for this deficiency.
这是一项来自中国江苏省南京医科大学附属脑科医院胸部医学科的单中心回顾性队列研究。目的是评估径向支气管内超声（R-EBUS）联合快速现场评估（ROSE）引导经支气管肺活检（TBLB）对肺气肿患者外周肺部病变（PPL）的诊断价值。
所有 170 例接受肺气肿 PPLs 检查的患者均接受 R-EBUS 检查，或联合或不联合 ROSE 检查，通过 SPSS 25.0 软件分析两组之间的诊断率、安全性以及可能影响诊断的因素。
两组的总体和良性诊断率无差异（P=0.224，0.924），但 ROSE 组恶性 PPLs 的诊断率明显高于无 ROSE 组（P=0.042）。ROSE 的灵敏度为 79.10%，特异性为 91.67%，阳性预测值为 98.15%，阴性预测值为 84.62%。诊断准确率为 95.52%。在 R-EBUS+ROSE 组中，操作时间和活检或刷检次数均明显减少（均 P<0.05）。R-EBUS+ROSE 组气胸（1.20%）和出血（10.84%）的发生率也低于 R-EBUS 组（均 P<0.05）。病变直径≥2cm、胸膜与病变距离≥2cm、阳性空气支气管征、超声探头在病变内的位置以及病变超声图像的均匀回声伴清晰边界特征，这些因素可能与更高的诊断率相关。无 ROSE 组中，与肺气肿相邻的 PPLs 的诊断率低于远离肺气肿的 PPLs（P=0.048），但在 R-EBUS+ROSE 组中，病变与肺气肿相邻与否并无差异（P=0.236）。
本研究发现，支气管镜检查过程中 R-EBUS 联合 ROSE 是一种安全有效的方法，可以提高肺气肿患者 PPLs 的诊断率，尤其是恶性 PPLs。病变与胸膜距离≥2cm、阳性空气支气管征、超声探头在病变内的位置以及病变超声图像的均匀回声伴清晰边界特征，这些因素可能提示更高的诊断率。病变位置与肺气肿相邻可能会降低诊断率，但 ROSE 可能弥补这一不足。
