Qi Qi, Fang Wanqin, Yang Linhui, Liu Yi, Xu Rui, Liu Dan
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
Ther Adv Respir Dis. 2025 Jan-Dec;19:17534666251355130. doi: 10.1177/17534666251355130. Epub 2025 Jul 13.
Radial endobronchial ultrasound (R-EBUS), virtual bronchoscopic navigation (VBN), and electromagnetic navigation bronchoscopy (ENB) are widely used bronchoscopic techniques for diagnosing peripheral pulmonary lesions (PPLs). However, the applications of their combinations remain unclear.
This study aimed to investigate the diagnostic performance and safety of R-EBUS versus its combination with ENB or VBN and lesion characteristics.
This study is a retrospective, single-center cohort study.
Patients who underwent R-EBUS without and with ENB or VBN (R-EBUS+ENB, R-EBUS+VBN) for peripheral pulmonary. Diagnostic yield, sensitivity, specificity, and complications were compared using inverse probability of treatment weighting (IPTW) for baseline difference adjustment.
R-EBUS, R-EBUS+ENB, and R-EBUS+VBN groups had diagnostic yields of 74.6%, 78.2%, and 73.0%, respectively (no significant differences after IPTW adjustment). Multimodal approaches significantly improved diagnostic yield in patients with emphysematous lungs (R-EBUS vs R-EBUS+ENB: odds ratio (OR): 3.51; 95% confidence interval (CI): 1.38-8.95; = 0.009; R-EBUS vs R-EBUS+VBN: OR: 3.14; 95% CI: 1.05-9.35; = 0.04). R-EBUS+ENB demonstrated superior diagnostic performance in lesions ⩽20 mm (OR: 3.58; 95% CI: 1.28-9.98; = 0.015), lesions with positive bronchial signs (OR: 1.98; 95% CI: 1.07-3.67; = 0.029), and solid lesions with combined positive bronchial signs (OR: 2.67; 95% CI: 1.18-6.07; = 0.019). Mild bleeding was more frequent in the R-EBUS+ENB group than in the R-EBUS group (OR: 3.21; 95% CI: 1.13-9.13; = 0.029); severe complications did not significantly differ among groups.
Comparable diagnostic performances were observed among R-EBUS, R-EBUS+ENB, and R-EBUS+VBN groups. Multimodal approaches significantly enhanced diagnostic accuracy in subtypes with lesions of small size, positive bronchial signs, or emphysematous lungs. These findings highlight the importance of tailored multimodal strategies to improve diagnostic yield and procedural safety in PPL evaluation.
径向支气管内超声（R-EBUS）、虚拟支气管镜导航（VBN）和电磁导航支气管镜检查（ENB）是广泛用于诊断周围型肺病变（PPL）的支气管镜技术。然而，它们联合应用的情况仍不明确。
本研究旨在探讨R-EBUS及其与ENB或VBN联合应用的诊断性能、安全性以及病变特征。
本研究为一项回顾性、单中心队列研究。
接受R-EBUS检查且未联合及联合ENB或VBN（R-EBUS+ENB、R-EBUS+VBN）用于周围型肺病变诊断的患者。采用治疗权重逆概率（IPTW）调整基线差异，比较诊断率、敏感性、特异性和并发症。
R-EBUS组、R-EBUS+ENB组和R-EBUS+VBN组的诊断率分别为74.6%、78.2%和73.0%（IPTW调整后无显著差异）。多模式方法显著提高了肺气肿患者的诊断率（R-EBUS与R-EBUS+ENB比较：优势比（OR）：3.51；95%置信区间（CI）：1.38-8.95；P = 0.009；R-EBUS与R-EBUS+VBN比较：OR：3.14；95% CI：1.05-9.35；P = 0.04）。R-EBUS+ENB在直径≤20 mm的病变（OR：3.58；95% CI：1.28-9.98；P = 0.015）、有支气管征阳性的病变（OR：1.98；95% CI：1.07-3.67；P = 0.029）以及有支气管征阳性的实性病变（OR：2.67；95% CI：1.18-；P = 0.019）中显示出更好的诊断性能。R-EBUS+ENB组轻度出血比R-EBUS组更常见（OR：3.21；95% CI：1.13-9.13；P = 0.029）；各组严重并发症无显著差异。
R-EBUS组、R-EBUS+ENB组和R-EBUS+VBN组的诊断性能相当。多模式方法显著提高了小尺寸病变、支气管征阳性或肺气肿亚型的诊断准确性。这些发现凸显了定制多模式策略对于提高PPL评估中诊断率和操作安全性的重要性。
