Lee Young Seok, Hong Kyung Soo, Jang Jong Geol, Ahn June Hong
Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, Republic of Korea.
Transl Lung Cancer Res. 2024 Oct 31;13(10):2500-2510. doi: 10.21037/tlcr-24-484. Epub 2024 Oct 25.
Chronic obstructive pulmonary disease (COPD) is associated with frequent complications after transthoracic biopsy. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used to diagnose peripheral pulmonary lesions (PPLs). However, the efficacy and safety of this procedure for the diagnosis of PPLs in patients with COPD remain poorly understood. We investigated the usefulness of RP-EBUS-TBLB for diagnosing PPLs in patients with COPD.
This retrospective observational study aimed to identify clinical outcomes of RP-EBUS-TBLB in patients with COPD. A total of 175 patients with COPD and 439 patients without COPD were included in this study. RP-EBUS-TBLB was performed without fluoroscopy using a guide sheath.
The overall diagnostic accuracies in patients with COPD and without COPD were 80.6% (141/175) and 78.8% (346/439), respectively. There was no significant difference in the diagnostic yield based on the severity of airflow limitation (80.0%, 81.4%, and 79.2% for mild, moderate, and severe to very airflow limitations, respectively; P=0.97). In patients with COPD, diagnostic yields for malignant and benign lesions were 85.6% (95/111) and 71.9% (46/64). In multivariable analyses, larger lesion size [≥30 mm; odds ratio (OR), 2.86; 95% confidence interval (CI): 1.10-7.45; P=0.03] and within the lesion on EBUS image (OR 9.29; 95% CI: 3.79-22.79; P<0.001) were associated with diagnostic success in patients with COPD, whereas lesion location of upper lobe (OR, 0.36; 95% CI: 0.14-0.92; P=0.03) were associated with diagnostic failure. The overall complication rate in our study was 7.4% (13/175) in patients with COPD. Pneumothorax occurred in 4.6% (8/175), and chest tube insertion was needed in 1.7% (3/175) of the patients.
RP-EBUS-TBLB can be used as an appropriate method to diagnose PPLs in patients with COPD. The size of the lesion (≥30 mm) and having the probe within the lesion were important for successful diagnosis. The location of the lesion in the upper lobe is associated with diagnostic failure. No difference was observed in the diagnostic yield based on the severity of airflow limitation. The complication rates were acceptable.
慢性阻塞性肺疾病（COPD）患者经胸活检后常出现并发症。径向探头支气管内超声引导下经支气管肺活检（RP-EBUS-TBLB）广泛用于诊断外周肺病变（PPL）。然而，该方法对COPD患者PPL诊断的有效性和安全性仍知之甚少。我们研究了RP-EBUS-TBLB对COPD患者PPL的诊断价值。
这项回顾性观察性研究旨在确定RP-EBUS-TBLB在COPD患者中的临床结果。本研究共纳入175例COPD患者和439例非COPD患者。使用引导鞘在无荧光透视的情况下进行RP-EBUS-TBLB。
COPD患者和非COPD患者的总体诊断准确率分别为80.6%（141/175）和78.8%（346/439）。根据气流受限严重程度的诊断率无显著差异（轻度、中度和重度至极重度气流受限分别为80.0%、81.4%和79.2%；P=0.97）。在COPD患者中，恶性和良性病变的诊断率分别为85.6%（95/111）和71.9%（46/64）。在多变量分析中，较大的病变大小[≥30mm；优势比（OR），2.86；95%置信区间（CI）：1.10-7.45；P=0.03]和EBUS图像上病变内（OR 9.29；95%CI：3.79-22.79；P<0.001）与COPD患者的诊断成功相关，而上叶病变位置（OR，0.36；95%CI：0.14-0.92；P=0.03）与诊断失败相关。我们研究中COPD患者的总体并发症发生率为7.4%（13/175）。气胸发生率为4.6%（8/175），1.7%（3/175）的患者需要插入胸管。
RP-EBUS-TBLB可作为诊断COPD患者PPL的合适方法。病变大小（≥30mm）和探头位于病变内对成功诊断很重要。病变位于上叶与诊断失败相关。根据气流受限严重程度的诊断率未观察到差异。并发症发生率可接受。
