背景:这是一项来自南京医科大学附属南京脑科医院胸科医疗区单中心的回顾性队列研究,江苏省,中国。目的探讨放射状支气管超声(R-EBUS)联合快速现场评估(ROSE)引导下经支气管肺活检(TBLB)对肺气肿患者周围型肺部病变的诊断价值。
方法:所有170例患有肺气肿的患者都接受了R-EBUS检查,无论是否进行ROSE检查,和诊断结果,安全,采用SPSS25.0软件对两组诊断可能的影响因素进行分析。
结果:两组的合并和良性诊断率没有差异(P=0.224,0.924),但ROSE组恶性PPL的诊断率明显高于无ROSE组(P=0.042)。ROSE的灵敏度为79.10%,特异性,91.67%,阳性预测值,98.15%,和阴性预测值,84.62%。诊断的准确性,为95.52%。在R-EBUS+ROSE组中,手术时间和活检或刷牙次数均显著减少(均P<0.05)。R-EBUS+ROSE组气胸发生率(1.20%)和出血发生率(10.84%)也低于R-EBUS组(P<0.05)。病变直径≥2cm,胸膜与病变之间的距离≥2cm,空气支气管图的阳性体征,超声探头在病变内的位置,病灶超声图像边缘特征清晰的均匀回声,这些因素可能与更高的诊断率有关.在无ROSE的组中,邻近肺气肿的PPL的诊断率低于远离肺气肿的PPL(P=0.048)。然而,在R-EBUS+ROSE组中,无论病变是否与肺气肿相邻,均无差异(P=0.236)。
结论:我们的研究发现,在支气管镜检查过程中,R-EBUS和ROSE的组合是一种安全有效的方式,可以提高肺气肿患者PPL的诊断率。尤其是恶性PPL。胸膜与病灶之间的距离≥2cm,空气支气管图的阳性体征,超声探头在病变内的位置,病灶超声图像边缘特征清晰的均匀回声,这些因素可能表明诊断结果较高.与肺气肿相邻的病变位置可能会降低诊断率,但ROSE可以弥补这种缺陷。
BACKGROUND: This is a retrospective cohort study from a single center of Chest Medical District of Nanjing Brain Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China. It was aim to evaluate the diagnostic value of radial endobronchial ultrasound (R-EBUS) combination with rapid on-site evaluation (ROSE) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions in patients with emphysema.
METHODS: All 170 patients who underwent PPLs with emphysema received an R-EBUS examination with or without the ROSE procedure, and the diagnostic yield, safety, and possible factors influencing diagnosis were analyzed between the two groups by the SPSS 25.0 software.
RESULTS: The pooled and benign diagnostic yields were not different in the two groups (P = 0.224, 0.924), but the diagnostic yield of malignant PPLs was significantly higher in the group with ROSE than the group without ROSE (P = 0.042). The sensitivity of ROSE was 79.10%, the specificity, 91.67%, the positive predictive value, 98.15%, and the negative predictive value, 84.62%. The diagnostic accuracy, was 95.52%. In the group of R-EBUS + ROSE, the procedural time and the number of times of biopsy or brushing were both significantly reduced (all P<0.05). The incidence of pneumothorax (1.20%) and bleeding (10.84%) in the group of R-EBUS + ROSE were also less than those in the group of R-EBUS (P<0.05). The lesion\'s diameter ≥ 2 cm, the distance between the pleura and the lesion ≥ 2 cm, the positive air bronchograms sign, the location of the ultrasound probe within the lesion, and the even echo with clear margin feature of lesion ultrasonic image, these factors are possibly relevant to a higher diagnostic yield. The diagnostic yield of PPLs those were adjacent to emphysema were lower than those PPLs which were away from emphysema (P = 0.048) in the group without ROSE, however, in the group of R-EBUS + ROSE, there was no such difference whether the lesion is adjacent to emphysema or not (P = 0.236).
CONCLUSIONS: Our study found that the combination of R-EBUS and ROSE during bronchoscopy procedure was a safe and effective modality to improve diagnostic yield of PPLs with emphysema, especially for malignant PPLs. The distance between the pleura and the lesion ≥ 2 cm, the positive air bronchograms sign, the location of the ultrasound probe within the lesion, and the even echo with clear margin feature of lesion ultrasonic image, these factors possibly indicated a higher diagnostic yield. Those lesions\' position is adjacent to emphysema may reduce diagnostic yield but ROSE may make up for this deficiency.