Bilaçeroğlu S, Kumcuoğlu Z, Alper H, Osma E, Cağirici U, Günel O, Bayol U, Celikten E, Perim K, Köse T
Department of Thoracic Medicine, Izmir Training Hospital for Thoracic Medicine and Surgery, Turkey.
Respiration. 1998;65(1):49-55. doi: 10.1159/000029237.
CT bronchus sign (BS) designates a bronchus leading directly to a peripheral pulmonary lesion. The objective of this investigation is to determine the contribution of BS-guided bronchoscopic multiple diagnostic procedures (BMDPs) to the diagnostic yield of solitary nodules or masses (SPNMs) suspected of pulmonary carcinoma (PC). A prospective study was carried out in 92 patients with a 2-5 cm diameter SPNM at the level of third to fifth bronchial branching and without endobronchial tumors. Within 10 days after 2-mm CT scans were done, in each of 92, bronchial washing (BW), brushing (BR), transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBB) were performed respectively, via fiberoptic bronchoscopy (FB) under fluoroscopic guidance. In 40 (82%) of 49 with BS and in 19 (44%) of 43 without BS, FB established the diagnosis (p < 0.01). In 84 cases of PC, BW, BR, TBNA and TBB provided the diagnostic yields of 4% (3), 26% (22), 57% (48) and 49% (41), respectively; the combined yield reached 68% (57). A metastasis and a tuberculoma were diagnosed exclusively by TBB, and TBNA, respectively. All differences of diagnostic yield except that between TBNA and TBB (p > 0.05) were determined to be significant (p < 0.05). Thoracotomy verified diagnosis in 48 of 59 cases diagnosed and 19 of 33 undiagnosed by FB, and various tissue biopsies or clinical follow-up in 11 diagnosed and 14 undiagnosed by FB. The above data suggest that in the diagnosis of PC as a SPNM at the level of third-fifth bronchial branching, combining the guidance of CT BS, and BMDPs under fluoroscopic guidance can increase the yield considerably.
CT支气管征（BS）指的是直接通向周围肺部病变的支气管。本研究的目的是确定BS引导下的支气管镜多项诊断程序（BMDPs）对疑似肺癌（PC）的孤立性结节或肿块（SPNMs）诊断率的贡献。对92例直径为2 - 5 cm、位于第三至第五支气管分支水平且无支气管内肿瘤的SPNMs患者进行了一项前瞻性研究。在完成2毫米CT扫描后的10天内，对92例患者中的每一例，在荧光透视引导下通过纤维支气管镜（FB）分别进行支气管灌洗（BW）、刷检（BR）、经支气管针吸活检（TBNA）和经支气管肺活检（TBB）。在49例有BS的患者中，40例（82%）通过FB确诊，在43例无BS的患者中，19例（44%）通过FB确诊（p < 0.01）。在84例PC患者中，BW、BR、TBNA和TBB的诊断率分别为4%（3例）、26%（22例）、57%（48例）和49%（41例）；联合诊断率达到68%（57例）。分别通过TBB和TBNA仅诊断出1例转移瘤和1例结核瘤。除TBNA和TBB之间的诊断率差异外（p > 0.05），所有诊断率差异均被确定为具有显著性（p < 0.05）。开胸手术在FB诊断的59例中的48例以及FB未诊断的33例中的19例中证实了诊断，在FB诊断的11例和未诊断的14例中进行了各种组织活检或临床随访。上述数据表明，在诊断位于第三至第五支气管分支水平的SPNMs为PC时，结合CT BS引导和荧光透视引导下的BMDPs可显著提高诊断率。
