Department of Thoracic, The Prince Charles Hospital, Brisbane.
UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, St Lucia QLD, Australia.
J Bronchology Interv Pulmonol. 2024 Nov 27;32(1). doi: 10.1097/LBR.0000000000000996. eCollection 2025 Jan 1.
Peripheral pulmonary lesions (PPLs) are frequently identified and require diagnostic sampling. Diagnostic yield of radial endobronchial ultrasound (rEBUS) guided bronchoscopic biopsies is suboptimal, despite ultrasound confirmation of navigation success. Pairing ultrathin bronchoscopy and peripheral transbronchial needle aspiration (pTBNA) may improve yield.
We prospectively recruited consecutive patients undergoing Olympus MP190F ultrathin bronchoscopy with rEBUS-guided sampling of PPLs. Cases were randomized to pTBNA (Olympus Periview FLEX) either before or after the usual transbronchial forceps biopsy (TBLBx) and brush. Diagnostic yield from cytology or histopathology, clinical outcomes to a minimum 24 months follow-up and complications were recorded.
One hundred one sampled lesions were included (pTBNA first 61, pTBNA last 40). Overall diagnostic yield was 66.3%, with no significant difference between groups (64% vs. 70% P=0.528) or prespecified subgroups according to sampling order. Seventy lesions had an end diagnosis of malignancy, of which 50 were correctly diagnosed (71.4%). TBLBx (49/96, 49%) and pTBNA (48/101, 47.5%) had the highest individual positive yield. For 12 (11.9%) participants, pTBNA was the only positive sample. Lesions <20 mm and those with eccentric rEBUS image seemed to benefit most from this approach. Rapid on-site cytologic examination (ROSE) was associated with both positive procedural diagnosis (P=0.019) and pTBNA-positive samples (P=0.004). Pneumothorax occurred in 4% and moderate bleeding in 5%. Thirteen percent had an unplanned admission within 1 month of bronchoscopy.
Adding pTBNA to conventional sampling through an ultrathin bronchoscope guided by rEBUS, improved diagnostic yield (11.9% additional diagnoses). The sampling sequence did not affect the yield of pTBNA.
外周肺部病变（PPL）经常被发现，需要进行诊断性取样。尽管超声确认了导航成功，但径向支气管内超声（rEBUS）引导下支气管镜活检的诊断率仍不理想。结合超薄支气管镜和经支气管外周针吸活检（pTBNA）可能会提高检出率。
我们前瞻性地招募了连续接受奥林巴斯 MP190F 超薄支气管镜检查和 rEBUS 引导下 PPL 取样的患者。病例被随机分为 pTBNA（奥林巴斯 Periview FLEX）组，分别在常规经支气管活检钳（TBLBx）和刷检之前或之后进行。记录细胞学或组织病理学的诊断率、至少 24 个月的临床结果和并发症。
共纳入 101 个取样病变（pTBNA 先进行 61 例，pTBNA 后进行 40 例）。整体诊断率为 66.3%，两组间无显著差异（64%与 70%，P=0.528），或按采样顺序预设的亚组间无显著差异。70 个病变的最终诊断为恶性，其中 50 个得到正确诊断（71.4%）。TBLBx（49/96，49%）和 pTBNA（48/101，47.5%）的单独阳性检出率最高。对于 12 名（11.9%）参与者，pTBNA 是唯一的阳性样本。直径<20mm 和偏心性 rEBUS 图像的病变似乎最受益于这种方法。快速现场细胞学检查（ROSE）与阳性程序诊断（P=0.019）和 pTBNA 阳性样本（P=0.004）均相关。气胸发生率为 4%，中度出血发生率为 5%。13%的患者在支气管镜检查后 1 个月内需要计划外住院。
在 rEBUS 引导的超薄支气管镜下常规取样中加入 pTBNA，提高了诊断率（增加了 11.9%的诊断）。采样顺序不影响 pTBNA 的检出率。
