背景:电磁导航支气管镜(ENB)和径向探头支气管超声(RP-EBUS)是诊断周围型肺部病变的必要支气管镜程序。尽管他们的个人优势,他们组合的最佳情况仍然不确定。
方法:这项单中心回顾性研究纳入了2021年12月至2022年12月期间接受ENB和/或RP-EBUS活检的473例529个肺结节患者。诊断产量是使用严格的,中间,自由的定义在严格的定义中,在索引程序时,只有恶性和特定的良性病变被认为是诊断性的.中间和自由定义包括后续期间的其他结果。
结果:严格定义的诊断率在三组之间没有统计学差异(ENB/组合/RP-EBUS63.8%/64.2%/62.6%,p=0.944)。然而,对于支气管II型或III型且实性部分<20mm的结节,ENB+RP-EBUS组的诊断率更优(比值比1.96,95%置信区间1.09-3.53,p=0.02).在并发症方面,ENB+RP-EBUS组的出血明显增多(ENB/组合/RP-EBUS3.7%/6.2/0.6%,p=0.002),但未观察到重大不良事件.
结论:ENB和RP-EBUS的组合提高了支气管II型或III型和实性部分<20mm的结节的诊断率,尽管出血风险略有升高。基于结节特征的仔细患者选择对于从这种组合方法中受益很重要。
BACKGROUND: Electromagnetic navigation bronchoscopy (ENB) and radial probe endobronchial ultrasound (RP-EBUS) are essential bronchoscopic procedures for diagnosing peripheral lung lesions. Despite their individual advantages, the optimal circumstances for their combination remain uncertain.
METHODS: This single-center retrospective study enrolled 473 patients with 529 pulmonary nodules who underwent ENB and/or RP-EBUS biopsies between December 2021 and December 2022. Diagnostic yield was calculated using strict, intermediate, and liberal definitions. In the strict definition, only malignant and specific benign lesions were deemed diagnostic at the time of the index procedure. The intermediate and liberal definitions included additional results from the follow-up period.
RESULTS: The diagnostic yield of the strict definition was not statistically different among the three groups (ENB/Combination/RP-EBUS 63.8%/64.2%/62.6%, p = 0.944). However, the diagnostic yield was superior in the ENB + RP-EBUS group for nodules with a bronchus type II or III and a solid part <20 mm (odds ratio 1.96, 95% confidence interval 1.09-3.53, p = 0.02). In terms of complications, bleeding was significantly higher in the ENB + RP-EBUS group (ENB/Combination/RP-EBUS 3.7% /6.2/0.6%, p = 0.002), but no major adverse event was observed.
CONCLUSIONS: The combination of ENB and RP-EBUS enhanced the diagnostic yield for nodules with bronchus type II or III and solid part <20 mm, despite a slightly elevated risk of bleeding. Careful patient selection based on nodule characteristics is important to benefit from this combined approach.