冷冻活检与细针抽吸用于形状感知机器人辅助小肺结节采样。

Cryobiopsy versus fine-needle aspiration for shape-sensing robotic-assisted sampling of small lung nodules.

机构信息

Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA.

出版信息

Lung Cancer. 2024 Oct;196:107967. doi: 10.1016/j.lungcan.2024.107967. Epub 2024 Sep 26.

DOI:10.1016/j.lungcan.2024.107967

PMID:39342768

Abstract

INTRODUCTION

Shape-sensing Robotic-assisted Bronchoscopy (ssRAB) has emerged as a promising tool for improved performance when sampling pulmonary nodules (PPN). Previous studies suggest that the 1.1 mm cryoprobe is as effective compared to fine needle aspiration (FNA), for different lesions sizes. We aim to compare the 1.1 mm cryoprobe performance to FNA for sampling PPN < 20 mm with ssRAB.

MATERIAL AND METHODS

We conducted a retrospective cohort study from November 2022 to February 2024 of patients who underwent ssRAB with cryobiopsy for evaluation of PPN. We compared the diagnostic yield and sensitivity for malignancy of cryobiopsy and FNA for the same PPN. Descriptive statistical analysis was conducted using the McNemar's Test and Comparison of proportion. Multivariate logistic regression assessed the impact of PPN characteristics on the yield of each tool.

RESULTS

We included 256 patients, with a combined 284 procedures, and 324 nodules sampled. The median maximum and minimum nodule size was 1.6 cm (IQR 1.17-2.4) and 1.17 cm (IQR 0.86-1.7) respectively. The overall ssRAB diagnostic yield was 93.8 % and sensitivity for malignancy was 97.5 %. Cryobiopsy had a diagnostic yield of 92 % and sensitivity of 96 %, FNA had a 70.4 % and 79.29 % respectively (P < 0.001). Cryobiopsy had a significantly higher performance compared to FNA across the analyzed categories (P < 0.05), except for the sensitivity of mixed-type lesions (P = 0.11). PPN < 10 mm and ≥ 10 mm - <15 mm sampled with FNA, had lower odds of achieving a diagnosis compared to the ≥ 20 mm group (OR = 0.305 IC95%: 0.142-0.65, p < 0.001; OR = 0.497 IC95%: 0.263-0.939, p = 0.031, respectively). Complications occurred in 5.98 % (N = 17) of cases.

CONCLUSION

Cryobiopsy demonstrates a statistically higher diagnostic yield and sensitivity for malignancy compared to FNA. Remarkably, FNA showed reduced diagnostic odds in PPN < 15 mm. ssRAB with cryobiopsy could enhance PPN diagnostic yield, leading to earlier lung cancer diagnosis and improve long-term survival rates.

摘要

介绍

形状感应机器人辅助支气管镜检查（ssRAB）已成为提高肺结节（PPN）采样性能的有前途的工具。先前的研究表明，1.1mm 冷冻探针与细针抽吸（FNA）相比，对于不同大小的病变同样有效。我们旨在比较 ssRAB 用于采样<20mm 的 PPN 时 1.1mm 冷冻探针与 FNA 的性能。

材料和方法

我们进行了一项回顾性队列研究，纳入了 2022 年 11 月至 2024 年 2 月期间接受 ssRAB 冷冻活检评估 PPN 的患者。我们比较了冷冻活检和 FNA 对相同 PPN 的恶性肿瘤诊断率和灵敏度。使用 McNemar 检验和比例比较进行描述性统计分析。多变量逻辑回归评估了 PPN 特征对每种工具产量的影响。

结果

我们纳入了 256 名患者，共进行了 284 次手术和 324 个结节采样。最大和最小结节直径的中位数分别为 1.6cm（IQR 1.17-2.4）和 1.17cm（IQR 0.86-1.7）。总的 ssRAB 诊断率为 93.8%，恶性肿瘤的灵敏度为 97.5%。冷冻活检的诊断率为 92%，灵敏度为 96%，FNA 的诊断率分别为 70.4%和 79.29%（P<0.001）。除了混合性病变的灵敏度外（P=0.11），冷冻活检在分析的所有类别中均显著优于 FNA（P<0.05）。与≥20mm 组相比，FNA 采样的<10mm 和≥10mm-<15mm 的 PPN 获得诊断的可能性更低（OR=0.305，95%CI：0.142-0.65，P<0.001；OR=0.497，95%CI：0.263-0.939，P=0.031）。5.98%（N=17）的病例发生了并发症。