EBUS-GS技术结合现场快速评价对肺外周结节的诊断价值

The diagnostic value of EBUS-GS combined with on-site rapid evaluation in peripheral pulmonary nodules

目的探讨经支气管超声引导鞘(EBUS-GS)技术结合快速现场评价(ROSE)对肺外周结节诊斷的临床价值。方法回顾性分析2017年2月-2018年9月收至住院的87例肺外周结节患者,随机分为2组,EBUS-GS+ROSE组46例,EBUS-GS组41例,活检组织最终行病理学检查,评价EBUS-GS对肺外周结节良恶性的初步诊断,比较ROSE和组织病理结果的符合率。结果87例患者活检病理确诊72例,15例未能获得明确诊断,其中恶性病变59例,良性病变13例。EBUS-GS技术对肺周围型恶性病变诊断率高于良性病变,差异有统计学意义(χ2=29.389,P=0.000);肺外周结节距肺门距离v4cm、5cm和v6cm的诊断率分别(88.89%、84.38%、68.42%),组间卡方检验,差异有统计学意义(χ2=8.083,P=0.018);而肺结节大小、部位、形态、有无支气管充气征的组间比较,差异无统计学意义;ROSE组与组织病理学结果一致性好(Kappa=0.751,P=0.000).ROSE组诊断恶性病变的灵敏度93.54%、特异度85.71%,阳性预测值96.66%,阴性预测值75%OEBUS-GS+ROSE联合组与单用EBUS-GS组比较,诊断率分别为82.61%、82.91%。首次活检完成时间分别为(31.64±1.948)min、(29.19±2.409)min,活检次数分别为(2.51±0.502)次、(2.91±0.474)次,差异均有统计学意义(P=0.000),二次检查、活检出血风险均较单用EBUS-GS次数减少,但差异无统计学意义(P>0.05).结论EBUS-GS对肺外周结节的恶性肿瘤诊断效能高;结合ROSE在肺部外周结节诊疗中快速评估,虽然在操作时间稍延长,但缩短了穿刺次数、减少二次检查风险,是有效且可靠的技术。

Objective To investigate the clinical diagnosis value of pulmonary peripheral nodules through EBUS-GS and ROSE. Methods A retrospective review of 87 patients who were diagnosed pulmonary peripheral nodules in December 2016 to May 2018. They were randomly divided into 2 groups, included 46 cases in EBUS-GS+ROSE group, while 41 cases in EBUS-GS group. The biopsy specimens were undertaken pathology examination. The diagnostic rate was compared through benign and malignant neoplasms by EBUS-GS. The coincidence rate of ROSE and the histopathological were compared. The value of ROSE for the early diagnosis of disease was further evaluated. Results In 87 patients, 72 patients were confirmed diagnosis by pathology, included 59 lung cancer patients. The malignant lesions diagnostic rates were higher than that in benign lesions. There were significant differences (χ2=29.389, P=0.000 ). The diagnostic rates of the lesions distance between peripheral pulmonary nodules and hilum<4cm, 5cm and 6cm were 8&89%, 84.38% and 68.42% respectively, there were significant differences (χ2=8.083, P=0.018 ). There was no significant difference in lesion size, position, form, bronchial aerated group of the two groups ( P>0.05 ).The result of ROSE was consistent with result of histopathology ( Kappa=0.751, P=0.000 ). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ROSE during transbronchial biopsy for solitary pulmonary nodules were 93.54%, 85.71%, 96.66%, 75%, respectively.The diagnose rate in EBUS-GS+ROSE group and EBUSGS group were 82.61% and 82.91% respectively.The time of biopsy were ( 31.64±1.948min ) and ( 29.19±2.409min) respectively, the number of biopsy were ( 2.51 ±0.502) times and ( 2.91±0.474 ) times, which was statistical difierence (P=0.000). Although the risk of bleeding in the second examination was lower than that in EBUS-GS group, but there was no statistical difference of above-mentioned data between the two groups (P>0.05). Conclusion EBUS-GS is a safe and reliable method for diagnosis of pulmonary peripheral nodules.United with ROSE can reduce the incidence rate of complication such as inspect bleeding and secondary inspection rate. It is still safe and reliable technology, although it can slightly prolong the operation time.