虚拟导航技术引导经支气管肺活检对肺外周结节的诊断价值

Diagnostic value of virtual bronchoscopic navigation guided transbronchial lung biopsy for peripheral pulmonary lesions

目的探讨虚拟导航引导经支气管肺活检对外周型肺孤立性小结节的诊断价值。方法回顾性分析2016年1月至12月于成都医学院第一附属医院呼吸内科通过不同方法经支气管肺组织活检的96例外周型肺孤立性小结节患者的临床资料,根据活检方法的不同分为传统活检钳肺活检组、虚拟导航引导活检钳肺活检组、虚拟导航引导冷冻肺活检组,比较3组间的诊断率及虚拟导航引导活检钳肺活检组和虚拟导航引导冷冻肺活检组的操作时间。结果传统活检钳肺活检组、虚拟导航引导活检钳肺活检组、虚拟导航引导冷冻肺活检组的病灶大小分别为(21±7) mm、(22±8) mm、(19±8) mm。3组比较差异无统计学意义(F=0.48,P=0.54)。传统活检钳肺活检组、虚拟导航引导活检钳肺活检组、虚拟导航引导冷冻肺活检组的诊断率分别为43.3%(13/30)、66.7%(23/35)和77.4%(24/31),传统活检钳肺活检组明显低于其他2个组(X^2=7.801,P=0.020),而虚拟导航引导活检钳肺活检组与虚拟导航引导冷冻肺活检组比较差异无统计学意义(X^2=1.099,P=0.295),且虚拟导航引导活检钳肺活检组与虚拟导航引导冷冻肺活检组在肺各个叶以及病灶良恶性间诊断率差异均无统计学意义(均P>0.05)。虚拟导航引导活检钳肺活检组与虚拟导航引导冷冻肺活检组的操作时间分别为(436±201) s和(363±185) s,两组差异有统计学意义(t=1.56,P=0.038)。结论虚拟导航技术引导经支气管肺活检术可以提高外周型肺孤立性小结节的诊断率,并且虚拟导航引导冷冻肺活检可以明显减少操作时间。

Objective To investigate the value of virtual bronchoscopic navigation guided transbronchial lung biopsy for peripheral pulmonary solitary nodules. Methods 96 patients with peripheral pulmonary lesions who experienced different manners of transbronchial lung biopsy in the First Affiliated Hospital of Chengdu Medical College between January and December 2016 were analyzed retrospectively. The patients were divided into a conventional forceps biopsy group, a virtual bronchoscopic navigation guided forceps biopsy group, a virtual bronchoscopic navigation guided cryorecanalization group. We compared the diagnostic yield and operation time among former three groups. Results The lesion size of the conventional forceps biopsy group, the virtual bronchoscopic navigation guided forceps biopsy group, the virtual bronchoscopic navigation guided cryorecanalization group were (21±7)mm,(22±8)mm,(19±8)mm. Furthermore, no significant difference was found in diagnostic yields by lesion size ( F =0.48, P =0.54).The conventional forceps biopsy group had the lowest diagnostic yield(43.3%,13/30) among the three groups(χ^2=7.801, P =0.020). And there was no significant difference in the diagnostic yield between the virtual bronchoscopic navigation guided forceps biopsy group and the virtual bronchoscopic navigation guided cryorecanalization group(χ^2=1.099, P =0.295). The virtual bronchoscopic navigation guided forceps biopsy group and the virtual bronchoscopic navigation guided cryorecanalization group did not have any variety in lesion location by pulmonary segment and histological findings. The procedure time remained significantly longer in the virtual bronchoscopic navigation guided forceps biopsy group(436±201)s than the virtual bronchoscopic navigation guided cryorecanalization group(363±185)s( t =1.56, P =0.038). Conclusions The virtual bronchoscopic navigation guided transbronchial lung biopsy might enhance the diagnostic yield in peripheral pulmonary lesions, and virtual bronchoscopic navigation cryorecanalization could decrease the procedure time.