Chang Hao-Chun, Kuo Yao-Wen, Lin Ching-Kai, Chang Lih-Chyun, Chen You-Yi, Yang Ching-Yao, Chien Jung-Yien, Hsu Chia-Lin, Tsai Tzu-Hsiu, Ho Chao-Chi, Shih Jin-Yuan, Yu Chong-Jen
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hsinchu Branch, Biomedical Park Hospital, Hsinchu County, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
ERJ Open Res. 2025 Mar 24;11(2). doi: 10.1183/23120541.00771-2024. eCollection 2025 Mar.
Radial probe endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) with a guide sheath (GS) is widely used to diagnose peripheral lung lesions (PPLs), but there is no consensus on whether it increases the diagnostic yield. We conducted this prospective study to compare the diagnostic yield of the GS method to the conventional method without a GS.
From November 2019 to March 2023, patients with PPLs were recruited and randomly assigned to rEBUS-TBB with a GS (GS group) or without a GS (conventional group). The histopathology, cytology and microbiology yield rates, as well as procedure time and post-procedure adverse events, of the two groups were compared.
A total of 102 patients were enrolled (54 in the GS group and 48 in the conventional group). The pathology yield showed no statistical difference between the two groups (75.9% 68.8%, p=0.418), while the yield rates of brushing cytology (64.3% 42.9%, p=0.030) and washing cytology (41.5% 20.0%, p=0.0443) were higher in the GS group. Meanwhile, the yield from GS washing culture was lower than the bronchial washing culture yield (0% 57.1%, p=0.017). The bleeding risk was also lower in the GS group (9.3% 20.8%, p=0.049).
The pathology yield of rEBUS TBB with a GS did not significantly differ from the conventional method. However, a GS could improve the cytology yield rate and reduce the risk of bleeding. To enhance the microbiology yield, additional bronchial washing should be utilised.
采用带有引导鞘（GS）的径向探头支气管内超声（rEBUS）引导下经支气管活检（TBB）广泛用于诊断周围型肺病变（PPL），但对于其是否能提高诊断率尚无共识。我们开展了这项前瞻性研究，以比较GS方法与无GS的传统方法的诊断率。
2019年11月至2023年3月，招募PPL患者并随机分为接受带GS的rEBUS-TBB组（GS组）或无GS组（传统组）。比较两组的组织病理学、细胞学和微生物学检出率，以及操作时间和术后不良事件。
共纳入102例患者（GS组54例，传统组48例）。两组间病理检出率无统计学差异（75.9%对68.8%，p = 0.418），而GS组的刷检细胞学检出率（64.3%对42.9%，p = 0.030）和灌洗细胞学检出率（41.5%对20.0%，p = 0.0443）更高。同时，GS灌洗培养的检出率低于支气管灌洗培养的检出率（0%对57.1%，p = 0.017）。GS组的出血风险也更低（9.3%对20.8%，p = 0.049）。
带GS的rEBUS TBB的病理检出率与传统方法无显著差异。然而，GS可提高细胞学检出率并降低出血风险。为提高微生物学检出率，应采用额外的支气管灌洗。
