冷冻活检对伴有磨玻璃影的周围型肺病变的诊断效能：一项倾向评分匹配分析
Diagnostic efficacy of cryobiopsy for peripheral pulmonary lesions with ground-glass opacity: a propensity score-matched analysis.
作者信息
Furuse Hideaki, Matsumoto Yuji, Nakai Toshiyuki, Tanaka Midori, Nishimatsu Kanako, Uchimura Keigo, Imabayashi Tatsuya, Tsuchida Takaaki
机构信息
Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
出版信息
Transl Lung Cancer Res. 2024 Sep 30;13(9):2175-2186. doi: 10.21037/tlcr-24-304. Epub 2024 Sep 12.
BACKGROUND
Peripheral pulmonary lesions (PPLs) with ground-glass opacity (GGO) are generally difficult to diagnose via bronchoscopy. Cryobiopsy, a recently introduced technique, provides quantitatively and qualitatively superior tissues compared with conventional biopsy methods and can improve diagnostic outcomes. However, its diagnostic accuracy has not been specifically investigated. Therefore, this study aimed to determine whether the combined use of cryobiopsy improves the diagnostic yield for PPLs with GGO.
METHODS
Consecutive patients who underwent bronchoscopy combined with radial endobronchial ultrasound and virtual bronchoscopic navigation for PPLs with GGO were retrospectively reviewed between June 2014 and May 2020. Cryobiopsy was introduced at our institution in June 2017. Patients who underwent only conventional biopsy (forceps and/or needle aspiration) between June 2014 and May 2017 were classified as the conventional group, whereas those who underwent cryobiopsy with or without conventional biopsy between June 2017 and May 2020 were categorized as the "cryo" group. The diagnostic performance of the two groups was compared using propensity score-matched analysis.
RESULTS
Overall, 553 cases were identified, including 250 and 303 in the cryo and conventional groups, respectively. Propensity scoring was implemented to match lesion characteristics and intraprocedural findings, leading to the selection of 232 pairs of cases for each matched (m) group. The diagnostic yield in the m-cryo group was significantly higher than that in the m-conventional group [88.8% 63.8%, odds ratio: 4.50 (95% confidence interval: 2.76-7.33), P<0.001]. Although the incidence of grade 2 and 3 bleeding in the m-cryo group was higher than that in the m-conventional group (40.5% 8.6% and 2.6% 0.4%, respectively; P<0.001), grade 4 bleeding was not reported.
CONCLUSIONS
The combined use of cryobiopsy provides improved diagnostic yield for PPLs with GGO compared with conventional biopsy methods.
背景
具有磨玻璃影（GGO）的周围型肺病变（PPLs）通常难以通过支气管镜检查进行诊断。冷冻活检是一种最近引入的技术，与传统活检方法相比，它能提供数量和质量上更优的组织，并且可以改善诊断结果。然而，其诊断准确性尚未得到专门研究。因此，本研究旨在确定联合使用冷冻活检是否能提高GGO型PPLs的诊断率。
方法
回顾性分析2014年6月至2020年5月期间连续接受支气管镜检查联合径向支气管内超声和虚拟支气管镜导航以诊断GGO型PPLs的患者。2017年6月我院引入了冷冻活检技术。2014年6月至2017年5月期间仅接受传统活检（钳夹和/或针吸）的患者被分类为传统组，而2017年6月至2020年5月期间接受了冷冻活检（无论是否联合传统活检）的患者被分类为“冷冻”组。使用倾向评分匹配分析比较两组的诊断性能。
结果
总体上，共识别出553例病例，冷冻组和传统组分别有250例和303例。实施倾向评分以匹配病变特征和术中发现，从而为每个匹配（m）组选择了232对病例。m-冷冻组的诊断率显著高于m-传统组[88.8%对63.8%，优势比：4.50（95%置信区间：2.76 - 7.33），P<0.001]。虽然m-冷冻组2级和3级出血的发生率高于m-传统组（分别为40.5%对8.6%和2.6%对0.4%；P<0.001），但未报告4级出血。
结论
与传统活检方法相比，联合使用冷冻活检可提高GGO型PPLs的诊断率。
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