Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules

Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules
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DOI：
10.1111/resp.12085
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发表时间：
2013-07-01
期刊：
RESPIROLOGY
影响因子：
6.9
通讯作者：
Tremblay, Alain
Tremblay, Alain
中科院分区：
医学2区
文献类型：
--
作者：
Chee, Alex;Stather, David R.;Tremblay, Alain

文献摘要

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背景和目的本研究旨在探讨外周支气管内超声（pEBUS）和按需电磁导航支气管镜检查（ENB）对外周肺结节采样的诊断价值。方法本研究是一项对周围型肺结节患者进行的前瞻性队列研究。最初使用带引导鞘的pEBUS探头进行外周肺病变定位。如果单独使用pEBUS定位失败，则使用ENB帮助识别病变。分别行支气管活检、支气管刷检、针吸及支气管冲洗。结果60例患者平均病变大小为27 mm，平均胸膜间距为20 mm。75%的病例仅用pEBUS发现病变。ENB的添加将病变定位改善至93%。然而，单独pEBUS和pEBUS联合ENB的诊断率分别为43%和50%。预测需要使用ENB的因素包括较小的病变大小和计算机断层扫描上没有支气管充气征。结论：ENB可改善pEBUS失败后肺部病变的定位，但通常不足以确保明确诊断。采样方法的技术改进可以提高诊断率。
Background and objective This study aimed to investigate the diagnostic utility of peripheral endobronchial ultrasound (pEBUS) followed by as-needed electromagnetic navigation bronchoscopy (ENB) for sampling peripheral lung nodules. Methods The study was a single-arm, prospective cohort study of patients with peripheral lung nodules. Peripheral lung lesion localization was initially performed using a pEBUS probe with guide sheath. If localization failed with pEBUS alone, ENB was used to help identify the lesion. Transbronchial biopsy, bronchial brush, transbronchial needle aspiration and bronchial washings were performed. Results Sixty patients were enrolled with average lesion size of 27mm and mean pleural distance of 20mm. Lesions were found with pEBUS alone in 75% of cases. The addition of ENB improved lesion localization to 93%. However, diagnostic yield for pEBUS alone and pEBUS with ENB were 43% and 50%, respectively. Factors predicting need for ENB use included smaller lesion size and absence of an air bronchus sign on computed tomography. Conclusions ENB improves localization of lung lesions after unsuccessful pEBUS but is often not sufficient to ensure confirmation of a specific diagnosis. Technical improvements in sampling methods could improve the diagnostic yield.