经引导鞘径向超声支气管镜肺活检对肺外周结节的诊断价值

Diagnostic Value of Guided Sheath Radial Probe Endobronchial Ultrasound-guided Transbronchial Lung Biopsy on Peripheral Pulmonary Lesions

目的:探讨分析经引导鞘径向超声支气管镜肺活检(RP-EBUS-GS-TBLB)诊断肺外周结节(PPL)阳性率。方法:回顾性分析2022年3月—2023年2月江西省人民医院收治的经胸部CT检查确诊为PPL的100例患者病例资料,所有患者均行RP-EBUS-GS-TBLB与径向超声支气管镜肺活检(RPEBUS-TBLB)。比较两种检查方法诊断PPL的阳性率。结果:RP-EBUS-GS-TBLB诊断PPL的总阳性率(71.00%)与二者联合诊断PPL的总阳性率(81.00%)均高于RP-EBUS-TBLB诊断PPL的总阳性率(45.00%),差异均有统计学意义(P<0.05)。RP-EBUS-GS-TBLB与二者联合诊断PPL间总阳性率比较,差异无统计学意义(P>0.05)。RP-EBUS-GS-TBLB与RP-EBUS-TBLB中不同探头位置、直径情况的病例间诊断PPL的阳性率,差异均有统计学意义(P<0.05);对于病灶直径≤20 mm、探头位置临近病灶的患者RP-EBUS-GS-TBLB诊断PPL的阳性率明显高于RP-EBUS-TBLB,差异均有统计学意义(P<0.05)。结论:与RP-EBUS-TBLB相比,RP-EBUS-GS-TBLB诊断PPL的阳性率更高,使用鞘管后再重复活检并不能提高其诊断阳性率,不同探头位置与病灶大小的PPL诊断阳性率存在明显差异;对于大于20 mm的病灶,使用引导鞘并不能提高诊断PPL的阳性率,对于探头位置临近病灶使用引导鞘可适当提高诊断PPL的阳性率。

Objective:To explore and analyze the positive rate of guided sheath radial probe endobronchial ultrasound-guided transbronchial lung biopsy(RP-EBUS-GS-TBLB)in the diagnosis of peripheral pulmonary lesions(PPL).Method:The case data of 100 patients with PPL confirmed by chest CT examination admitted to Jiangxi Provincial People's Hospital from March 2022 to February 2023 were retrospectively analyzed.All patients underwent RP-EBUS-GS-TBLB and radial probe endobronchial ultrasound-guided transbronchial lung biopsy(RP-EBUS-TBLB).The positive rate of PPL was compared between the two examination methods.Result:The total positive rate of RP-EBUS-GS-TBLB(71.00%)or the combination of the two examinations(81.00%)in diagnosing PPL was higher than that of RP-EBUS-TBLB(45.00%),the differences were statistically significant(P<0.05).There was no statistical difference in the total positive rate between RP-EBUS-GS-TBLB and the combination of two examinations in the diagnosis of PPL(P>0.05).There were statistical differences in the diagnostic positive rates of PPL between RP-EBUS-GS-TBLB and RP-EBUS-TBLB the in different probe positions and diameters in the diagnosis(P<0.05),the diagnostic positive rate of PPL of RP-EBUS-GS-TBLB in patients with lesion diameter≤20 mm and probe position near the lesion were significantly higher than those of RP-EBUS-TBLB,the differences were statistically significant(P<0.05).Conclusion:Compared with RP-EBUS-TBLB,RP-EBUS-GS-TBLB has a higher positive rate in the diagnosis of PPL.Repeated biopsy after the application of sheath canal can not enhance the diagnostic positive rate.There is a significant difference in the diagnostic positive rate of PPL among different probe positions and lesion sizes.For lesions larger than 20 mm,the application of guided sheath does not improve the positive rate of PPL,and can appropriately enhance the diagnostic positive rate of PPL for lesions near the probe position.