超细支气管镜和常规支气管镜对周围型肺病变的诊断价值研究

Comparison of ultrathin bronchoscopy with conventional bronchoscopy for the diagnostic value of peripheral pulmonary lesions

目的比较新一代超细支气管镜(UTB)和常规支气管镜(CB)在径向超声(rEBUS)引导下对周围型肺病变(PPL)的诊断价值。方法连续性收集苏州大学附属独墅湖医院2021年6月1日至2023年5月31日期间行多模式支气管镜检查的39例PPL患者的临床资料。多模式支气管镜检查方式表现为同一医师序贯使用CB(先端部外径为4.9或5.9 mm,工作通道内径为2或3 mm,CB组)和UTB(先端部外径为3 mm,工作通道内径为1.7 mm,UTB组)联合径向超声经支气管透壁肺活检(rEBUS-TBLB)。以病理结果和临床随访6个月的诊断结果为金标准,比较两种支气管镜活检标本的诊断率、rEBUS超声特点及探及率,以探索UTB联合rEBUS的临床应用价值。配对的二分类变量资料用McNemar检验,配对的连续性变量或等级资料用Wilcoxon符号秩和检验。结果UTB和CB两组诊断率分别为66.67%(26/39)和30.77%(12/39),UTB组明显高于CB组(χ^(2)=10.56,P=0.001,1-β=0.968)。CB组13例超声探头未探及病灶,19例临近病灶,7例在病灶内。替换UTB后,7例超声探头图像由未探及转变为临近病灶,3例未探及转变为病灶内,12例临近病灶转变为病灶内。UTB明显改善超声探头在病灶的位置(Z=-4.46,P<0.001)。UTB-rEBUS和CB-rEBUS探及率(超声图像显示临近病灶或在病灶内)分别为92.30%(36/39)和66.67%(26/39),UTB提高超声探头探及率(χ^(2)=8.10,P=0.002)。UTB提高实性、病灶直径>30 mm、非上叶、任何病变性质、无论有无支气管充气征的诊断。结论UTB诊断率明显高于CB,提供的超声图像优于CB,对PPL诊断优势明显。

Objective To assess and compare the diagnostic efficacy of next-generation ultrathin bronchoscopy(UTB)and conventional bronchoscopy(CB),both combined with radial endobronchial ultrasound(r-EBUS),in the evaluation of peripheral pulmonary lesions(PPL).Methods A cohort of 39 patients with PPL who underwent multimodal bronchoscopy at Dushu Lake Hospital,Soochow University,from June 1,2021 to May 31,2023 was consecutively enrolled.A single bronchoscopist performed multimodal bronchoscopies using CB(external diameter 4.9 mm or 5.9 mm,working channel diameter 2 or 3 mm,CB group)for transbronchial biopsy under r-EBUS guidance(rEBUS-TBLB),followed by UTB(external diameter 3 mm,working channel diameter 1.7 mm,UTB group)for transbronchial biopsy under r-EBUS guidance.Pathological findings and a 6-month clinical follow-up were used as the gold standard to compare the diagnostic yield of biopsy specimens,ultrasound characteristics,and localization rates of the two bronchoscope types.The aim was to evaluate the clinical application value of UTB combined with r-EBUS.Binary variables were analysed using the McNemar test for paired data.Continuous variables or ranked data were analysed using the Wilcoxon signed-rank test for paired data.Results The diagnostic yields for UTB and CB groups were 66.67%(26/39)and 30.77%(12/39),respectively,with the UTB group significantly surpassing the CB group(χ^(2)=10.56,P=0.001,1-β=0.968).r-EBUS with CB exhibited no visible lesion in 13 cases,adjacent to the lesion in 19 cases,and within the lesion in 7 cases.Substitution of UTB resulted in r-EBUS images changing from no visible lesion to adjacent to the lesion in 7 cases,from no visible lesion to within the lesion in 3 cases,and from adjacent to the lesion to within the lesion in 12 cases.The positioning of the r-EBUS probe in relation to the lesions improved significantly with UTB usage(Z=-4.46,P<0.001).Localization rates(number of patients with"within"or"adjacent to"the image/total number of patients)for UTB and CB were 92.30%(36/39)and 66.67%(26/39),respectively(χ^(2)=8.10,P=0.002).UTB improved r-EBUS probe localization rates.The diagnostic yields of UTB were higher than CB for solid lesions,lesions>30 mm in diameter,non-upper lobar location,benign or malignant lesions and lesions with or without a bronchus sign.Conclusion The UTB group demonstrated a significantly higher diagnostic yield than the CB group,providing superior r-EBUS probe images,and a significant diagnostic advantage for PPL.