背景:可以使用各种技术对周围型肺部病变进行采样,包括计算机断层扫描引导的经胸穿刺,电磁导航支气管镜,虚拟导航支气管镜,经支气管镜经径向探头支气管内超声肺活检。可以使用凸形探头支气管内超声引导的经支气管针吸活检(CEBUS-TBNA)和内窥镜超声细针吸活检等技术对纵隔病变进行采样。然而,有效,缺乏针对邻近节段或节段下支气管的病变的安全技术。在这里,我们回顾性评估了径向探头支气管内超声辅助经支气管针吸活检术(REBUS-TBNA)对节段支气管附近病变的诊断率和安全性,并探讨了与诊断产量相关的因素。
方法:我们回顾性分析了2019年1月至2022年12月在我科进行的REBUS-TBNA病例的诊断率和安全性。观察组患者对邻近节段支气管的病变行REBUS-TBNA治疗;对照组患者对纵隔或肺门病变行CEBUS-TBNA治疗。患者特征和病变大小,诊断产量,不良事件,并分析诊断率与临床特征的关系。
结果:组间性别差异无统计学意义,年龄,诊断产量,或不良事件的发生率。观察组(n=25;男性17,8名女性)的平均年龄为64.76±10.75岁。平均病灶大小为4.66±1.07cm,病变主要在上叶(80%)。REBUS-TBNA诊断率为84%,没有不良事件的报告。诊断结果与病变大小或支气管狭窄程度无关;然而,与穿刺次数呈正相关。>3次穿刺的患者的诊断率明显高于≤3次穿刺的患者。
结论:REBUS-TBNA是一种安全的,有效的诊断技术,特别是上叶节段或下段支气管附近的病变。在手术过程中执行三次以上的穿刺提高了诊断产量。有必要进行大规模的研究来证实这些结果,并进一步探讨REBUS-TBNA的临床应用价值。
BACKGROUND: Peripheral lung lesions can be sampled using various techniques, including computer tomography-guided transthoracic needle aspiration, electromagnetic navigation bronchoscopy, virtual navigation bronchoscopy, and radial probe endobronchial ultrasound transbronchial lung biopsy. Mediastinal lesions can be sampled using techniques like convex probe endobronchial ultrasound-guided transbronchial needle aspiration (CEBUS-TBNA) and endoscopic ultrasound-fine-needle aspiration. However, effective, safe techniques for lesions adjacent to the segmental or subsegmental bronchi are lacking. Herein, we retrospectively evaluated the diagnostic yield and safety of radial probe endobronchial ultrasound-assisted transbronchial needle aspiration (REBUS-TBNA) for lesions adjacent to the segmental bronchi, and explored the factors related to diagnostic yield.
METHODS: We retrospectively analyzed the diagnostic yield and safety of REBUS-TBNA cases performed in our department from January 2019 to December 2022. Observation group patients had undergone REBUS-TBNA for lesions adjacent to the segmental bronchi; control group patients had undergone CEBUS-TBNA for mediastinal or hilar lesions. Patient characteristics and lesion sizes, diagnostic yield, adverse events, and relations between diagnostic yield and clinical characteristics were analyzed.
RESULTS: There were not statistically significant between-group differences in sex, age, diagnostic yield, or rate of adverse events. The observation group (n = 25; 17 male, 8 female) had a mean age of 64.76 ± 10.75 years. The average lesion size was 4.66 ± 1.07 cm, and lesions were predominantly in the upper lobes (80%). REBUS-TBNA diagnostic yield was 84%, with no adverse events reported. Diagnostic yield was not associated with lesion size or extent of bronchial stenosis; however, it was positively correlated with number of punctures. Patients with > 3 punctures had a significantly higher diagnostic yield than those with ≤ 3 punctures.
CONCLUSIONS: REBUS-TBNA is a safe, effective diagnostic technique, particularly for lesions adjacent to the segmental or subsegmental bronchi of the upper lobe. Performing more than three punctures during the procedure improves the diagnostic yield. Larger-scale studies are warranted to confirm these results, and to further explore the clinical value of REBUS-TBNA.