Ho Rong Lih, Ahn Joong Hyun, Han Jung Ho, Choe Junsu, Shin Sun Hye, Jeong Byeong-Ho, Eom Sang-Won, Kim Hojoong, Lee Kyungjong
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Respiratory, Queen Elizabeth Hospital, Sabah, Malaysia.
Transl Lung Cancer Res. 2025 May 30;14(5):1611-1621. doi: 10.21037/tlcr-2025-68. Epub 2025 May 28.
Diagnosing pulmonary lesions remains challenging despite various modalities. The PeriView Flex aspiration needle offers a promising solution to forceps biopsy limitations. This study aims to assess whether combining radial endobronchial ultrasound (rEBUS)-guided transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) may enhance tissue acquisition for inaccessible lesions using forceps.
This retrospective study included 33 patients with pulmonary lesions who underwent a combination of rEBUS-guided TBNA and TBLB between September 2023 and August 2024. Diagnostic yields were calculated using a strict definition and were compared with those of propensity score-matched controls who underwent rEBUS-guided TBLB alone.
The median age of the cohort was 68 years, with a male-to-female ratio of 1.2:1.0. About 65% of lesions were in the outer two-thirds of the thorax, with a median size of 16.75 mm (interquartile range: 13.00-23.88 mm). Most lesions were solid (81.8%), followed by consolidation (9.1%), part-solid (6.1%) and cavitary lesions (3%). In our cohort, 21.2% had type Ia and 15.2% had type Ib, classified as favorable bronchial patterns on computed tomography (CT). However, approximately two-thirds had unfavorable bronchial patterns, including type Ic (12.1%), IIa (45.5%), and IIb (6.1%). An adjacent rEBUS view was present in 52% of the cases. The combined TBNA-TBLB approach achieved a diagnostic yield of 66.7%, which was highest in CT bronchus types Ia and Ib (83.3%) and lowest in types Ic, IIa, and IIb (57.1%). Propensity score matching (1:3) showed a higher diagnostic yield with TBNA-TBLB (66.7%) than with TBLB alone (48.5%), P=0.10. Post-procedural pneumothorax occurred in one patient (3.0%) in TBNA-TBLB group compare to 2.3% in TBLB group.
Adding TBNA to TBLB improved the diagnostic yield for pulmonary nodules with adjacent or tunnel-type bronchi. This combined approach offers a practical strategy for enhancing diagnostic accuracy.
尽管有多种检查方式，但诊断肺部病变仍然具有挑战性。PeriView Flex穿刺针为钳取活检的局限性提供了一个有前景的解决方案。本研究旨在评估联合使用径向支气管内超声（rEBUS）引导下经支气管针吸活检（TBNA）和经支气管肺活检（TBLB）是否可以提高使用钳取法获取难以触及病变组织的成功率。
这项回顾性研究纳入了33例肺部病变患者，这些患者在2023年9月至2024年8月期间接受了rEBUS引导下的TBNA和TBLB联合检查。采用严格的定义计算诊断阳性率，并与仅接受rEBUS引导下TBLB的倾向评分匹配对照组进行比较。
该队列的中位年龄为68岁，男女比例为1.2:1.0。约65%的病变位于胸腔外三分之二，中位大小为16.75毫米（四分位间距：13.00 - 23.88毫米）。大多数病变为实性（81.8%），其次为实变（9.1%）、部分实性（6.1%）和空洞性病变（3%）。在我们的队列中，21.2%为Ia型，15.2%为Ib型，在计算机断层扫描（CT）上被分类为有利的支气管模式。然而，约三分之二具有不利的支气管模式，包括Ic型（12.1%）、IIa型（45.5%）和IIb型（6.1%）。52%的病例存在相邻的rEBUS视野。TBNA - TBLB联合方法的诊断阳性率为66.7%，在CT支气管类型Ia和Ib中最高（83.3%），在Ic型、IIa型和IIb型中最低（57.1%）。倾向评分匹配（1:3）显示，TBNA - TBLB组的诊断阳性率（66.7%）高于单独TBLB组（48.5%），P = 0.10。TBNA - TBLB组有1例患者（3.0%）发生术后气胸，而TBLB组为2.3%。
在TBLB基础上增加TBNA可提高具有相邻或隧道型支气管的肺结节的诊断阳性率。这种联合方法为提高诊断准确性提供了一种实用策略。
