Electromagnetic Navigational Bronchoscopy in the Diagnosis of Lung Lesions
Electromagnetic Navigational Bronchoscopy in the Diagnosis of Lung Lesions
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DOI：
10.1097/lbr.0b013e31824dd9a1
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发表时间：
2012-04-01
影响因子：
3.3
通讯作者：
Simpson, Steven Q.
中科院分区：
文献类型：
--
作者：
Brownback, Kyle R.;Quijano, Franklin;Simpson, Steven Q.
背景：支气管镜不可见的肺部病变的诊断是一个具有挑战性的过程。电磁导航支气管镜（ENB）是一种旨在诊断周围肺部病变的新技术。我们试图确定 ENB 的诊断率是否受到支气管体征、病变位置或大小的影响。方法：从 2008 年以来在我们机构接受 ENB 的所有患者回顾性获得数据。ENB 由 3 名独立的程序专家在我们机构从 2008 年 11 月至 2011 年 7 月使用 superDimension/InReach 系统进行。患者的选择和标本采集的方式由程序专家决定。所有手术均使用全身麻醉和透视进行。记录病变大小、位置、ENB 诊断和最终诊断。结果：2008 年至 2011 年间，55 名患者接受了 ENB。平均病变大小为 3.0 cm，大多数病变位于上叶（34/55 病变）。 55 例患者中，41 例通过 ENB 确诊，诊断率为 74.5%。 36 名患者最终被诊断出患有恶性肿瘤，其中 25 名患者通过 ENB 诊断，恶性肿瘤的敏感性为 69.4%。 ENB 手术对恶性肿瘤的阴性预测值为 54.2%。术后出现呼吸衰竭2例，但无气胸病例。支气管征、病变大小和位置不影响诊断率。结论：ENB 在肺部病变的诊断中显示出可接受的诊断率和出色的安全性。使用透视和全身麻醉可以提高诊断率。
Background: The diagnosis of pulmonary lesions that are not bronchoscopically visible is a challenging process. Electromagnetic navigation bronchoscopy (ENB) is a new technology designed to diagnose peripheral pulmonary lesions. We sought to determine whether diagnostic yield from ENB was affected by bronchus sign, lesion location, or size.Methods: Data were obtained retrospectively from all patients undergoing ENB at our institution since 2008. ENB was performed by 3 separate proceduralists at our institution from November 2008 until July 2011 using the superDimension/InReach system. Patient selection and modalities of specimen collection were at the discretion of the proceduralist. All procedures were performed using general anesthesia and fluoroscopy. Lesion size, location, diagnosis from ENB, and eventual diagnosis were recorded.Results: Fifty-five individuals underwent ENB between 2008 and 2011. The average lesion size was 3.0 cm and the majority of lesions were located in the upper lobes (34/55 lesions). Of the 55 patients, in 41, a diagnosis was established from ENB, a diagnostic yield of 74.5%. Thirty-six patients were eventually diagnosed with a malignancy, of whom 25 were diagnosed by ENB, yielding a sensitivity for malignancy of 69.4%. The negative predictive value for malignancy with an ENB procedure was 54.2%. There were 2 cases of postprocedure respiratory failure, but there were no cases of pneumothorax. Bronchus sign, lesion size, and location did not affect the diagnostic yield.Conclusions: ENB shows an acceptable diagnostic yield with an excellent safety profile in the diagnosis of pulmonary lesions. The use of fluoroscopy and general anesthesia may improve the diagnostic yield.