Lai R S, Lee S S, Ting Y M, Wang H C, Lin C C, Lu J Y
Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China.
Respir Med. 1996 Mar;90(3):139-43. doi: 10.1016/s0954-6111(96)90155-9.
In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs. The objective of this study is to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) under fluoroscopic guidance in SPNs such as lung cancer or pulmonary tuberculoma in areas with high prevalence of tuberculosis. One hundred and seventy patients with SPNs on chest radiographs were included in the study; all had negative sputum smears for tubercle bacilli and no malignancy by sputum cytology before bronchoscopy. Transbronchial lung biopsy and brushing were performed, routinely, under fluoroscopic guidance. Of 170 patients, 120 (70.6%) had lung cancer (including three with metastatic cancer), 40 (23.5%) patients had pulmonary tuberculosis (Tb), and the remaining 10 (5.9%) patients had other benign pulmonary lesions. The overall diagnostic rate in SPNs was 62.4% (106 of 170). Transbronchial lung biopsy and brushing revealed a diagnostic sensitivity of 70.0% in lung cancer (84 of 120) and a sensitivity of 55% in Tb (22 of 40). In addition, TBLB and brushing also provided rapid microscopic identification of Tb in 18 of 40 patients (45%, including 15 by TBLB, one by brushing smear, and two by postbronchoscopic sputum). The percentage of positive diagnosis correlated with diameter of the SPN. Solitary pulmonary nodules with diameter less than 2 cm were diagnosed in only 35.3% of cases (6 of 17; cancer 40% vs. Tb 29%). In contrast, the diagnostic rates in SPNs with diameters 2-4 cm and greater than 4 cm were 64.5% (78 of 121; cancer 72.0% vs. Tb 62.5%) and 68.8% of cases (22 of 32), respectively. Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule since it may provide additional information to minimize unnecessary thoracotomy and give way for proper medication as early as possible.
在结核病流行地区，有许多病例在胸部X光片上表现为孤立性肺结节（SPN）。本研究的目的是评估在结核病高流行地区，荧光镜引导下经支气管肺活检（TBLB）对肺癌或肺结核瘤等SPN的诊断率。本研究纳入了170例胸部X光片显示有SPN的患者；所有患者痰涂片结核杆菌均为阴性，且在支气管镜检查前痰细胞学检查未发现恶性肿瘤。常规在荧光镜引导下进行经支气管肺活检和刷检。170例患者中，120例（70.6%）患有肺癌（包括3例转移性癌），40例（23.5%）患有肺结核（Tb），其余10例（5.9%）患有其他良性肺部病变。SPN的总体诊断率为62.4%（170例中的106例）。经支气管肺活检和刷检显示，肺癌的诊断敏感性为70.0%（120例中的84例），Tb的敏感性为55%（40例中的22例）。此外，TBLB和刷检还在40例患者中的18例（45%，包括15例通过TBLB、1例通过刷检涂片、2例通过支气管镜检查后痰液）中快速进行了Tb的显微镜鉴定。阳性诊断百分比与SPN直径相关。直径小于2 cm的孤立性肺结节仅在35.3%的病例中得到诊断（17例中的6例；癌症40% vs. Tb 29%）。相比之下，直径2 - 4 cm和大于4 cm的SPN的诊断率分别为64.5%（121例中的78例；癌症72.0% vs. Tb 62.5%）和68.8%（32例中的22例）。荧光镜引导下的诊断性支气管镜检查是评估周围型肺结节患者的有用工具，因为它可以提供额外信息，尽量减少不必要的开胸手术，并尽早为适当用药提供依据。
