经支气管超声引导针吸活检术联合使用超细支气管镜提高周围型肺部结节的诊断率及定位率

Value of ultrathin bronchoscope in improving the endobronchial ultrasound localization rate and diagnosing peripheral pulmonary nodules by cryobiopsy.

机构信息

Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, China.

Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

出版信息

BMC Pulm Med. 2024 Sep 5;24(1):439. doi: 10.1186/s12890-024-03256-7.

DOI:10.1186/s12890-024-03256-7

PMID:39237960

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11378380/

Abstract

BACKGROUND

A 3.0-mm ultrathin bronchoscope (UTB) with a 1.7-mm working channel provides better accessibility to peripheral bronchi. A 4.0-mm thin bronchoscope with a larger 2.0-mm working channel facilitates the use of a guide sheath (GS), ensuring repeated sampling from the same location. The 1.1-mm ultrathin cryoprobe has a smaller diameter, overcoming the limitation of the size of biopsy instruments used with UTB. In this study, we compared the endobronchial ultrasound localization rate and diagnostic yield of peripheral lung lesions by cryobiopsy using UTB and thin bronchoscopy combined with GS.

METHODS

We retrospectively evaluated 133 patients with peripheral pulmonary lesions with a diameter less than 30 mm who underwent bronchoscopy with either thin bronchoscope or UTB from May 2019 to May 2023. A 3.0-mm UTB combined with rEBUS was used in the UTB group, whereas a 4.0-mm thin bronchoscope combined with rEBUS and GS was used for the thin bronchoscope group. A 1.1-mm ultrathin cryoprobe was used for cryobiopsy in the two groups.

RESULTS

Among the 133 patients, peripheral pulmonary nodules in 85 subjects were visualized using r-EBUS. The ultrasound localization rate was significantly higher in the UTB group than in the thin bronchoscope group (96.0% vs. 44.6%, respectively; P < 0.001). The diagnostic yield of cryobiopsy specimens from the UTB group was significantly higher compared to the thin bronchoscope group (54.0% vs. 30.1%, respectively; p = 0.006). Univariate analysis demonstrated that the cryobiopsy diagnostic yields of the UTB group were significantly higher for lesions ≤ 20 mm, benign lesions, upper lobe lesions, lesions located lateral one-third from the hilum, and lesions without bronchus sign.

CONCLUSIONS

Ultrathin bronchoscopy combined with cryobiopsy has a superior ultrasound localization rate and diagnostic yield compared to a combination of cryobiopsy and thin bronchoscopy.

摘要

背景

3.0mm 超微支气管镜（UTB）具有 1.7mm 的工作通道，可更好地进入外周支气管。4.0mm 薄支气管镜具有更大的 2.0mm 工作通道，便于使用引导鞘（GS），确保从同一位置进行多次采样。1.1mm 超微冷冻探针的直径更小，克服了与 UTB 一起使用的活检仪器尺寸的限制。在这项研究中，我们比较了使用 UTB 和薄支气管镜联合 GS 进行冷冻活检时，对外周肺病变的支气管内超声定位率和诊断率。

方法

我们回顾性评估了 2019 年 5 月至 2023 年 5 月期间因直径小于 30mm 的周围性肺部病变而行支气管镜检查的 133 例患者。UTB 组采用 3.0mm UTB 联合 rEBUS，薄支气管镜组采用 4.0mm 薄支气管镜联合 rEBUS 和 GS。两组均采用 1.1mm 超微冷冻探针进行冷冻活检。

结果

在 133 例患者中，85 例患者的周围性肺结节可通过 r-EBUS 显示。UTB 组的超声定位率明显高于薄支气管镜组（96.0%比 44.6%；P<0.001）。UTB 组的冷冻活检标本的诊断率明显高于薄支气管镜组（54.0%比 30.1%；P=0.006）。单因素分析表明，UTB 组的冷冻活检诊断率对于≤20mm、良性病变、上叶病变、位于隆突外侧 1/3 处的病变和无支气管征的病变显著更高。