虚拟支气管镜导航联合径向超声支气管镜在周围型肺癌中的诊断意义

Diagnostic value of ultrasound image features combined with virtual bronchoscopic navigation and radial endobronchial ultrasound in peripheral lung cancer

目的分析虚拟支气管镜导航(virtual bronchoscopic navigation,VBN)联合径向超声支气管镜(radial endobronchial ultrasound,R-EBUS)在周围型肺癌中的诊断意义。方法选择2022年1月至2024年1月我院收治的行VBN+R-EBUS引导肺穿刺活检96例患者,采用χ^(2)检验比较结节均质/非均质回声、边界特征、CT影像学诊断与组织病理诊断相关性,采用Logistic回归分析,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线,分析R-EBUS超声图像特征在周围型肺癌中的诊断意义。结果R-EBUS超声显示实性均质回声66例(68.75%),实性非均质回声30例(43.48%);边界清楚57例(59.38%),边界欠清楚39例(40.62%)。术前经肺螺旋CT诊断为肺癌67例(69.79%),其他非肿瘤疾病29例(30.21%)。组织病理学诊断肺肿瘤58例(60.42%),其中腺癌39例(40.63%),鳞癌9例(9.38%),其他肿瘤10例(10.42%);组织病理学诊断非肿瘤疾病38例(39.58%),其中炎症24例(25.00%),局灶肉芽肿性炎或结核6例(6.25%),其他非肿瘤疾病8例(8.33%)。均质回声及组织病理诊断为肺癌51例(53.13%)、非肺癌15例(15.63%),非均质回声组织病理学诊断为肺癌7例(7.29%),非肺癌23例(23.96%)。均质回声与肺癌组织病理诊断相关(P<0.001),回声诊断肺癌的灵敏度为87.93%,特异度为60.53%。边界欠清楚及组织病理诊断为肺癌24例(25.00%)、非肺癌34例(35.41%),边界清楚组织病理诊断为肺癌15例(15.63%),非肺癌23例(23.96%),边界特征与肺癌组织病理诊断不关联(P>0.05)。Logistic回归分析显超声回声、肺CT,以及超声回声联合肺CT三种检测方法与肺癌组织病理诊断有一致性(P<0.001),ROC曲线分析显示,超声回声AUC:0.7423,肺CT AUC:0.7945,超声回声联合肺CT AUC:0.8827。结论R-EBUS超声图像中实性均质回声与肺癌组织病理诊断显著相关,R-EBUS联合CT影像学可提升肺癌诊断准确率。

Objective To evaluate the diagnostic value of virtual bronchoscopic navigation(VBN)combined with radial endobronchial ultrasound(R-EBUS)in peripheral lung cancer.Methods A total of 96 patients who underwent VBN+R-EBUS guided lung biopsy in our hospital from January 2022 to January 2024 were selected.Chi-square test was used to compare the correlation between homogeneous/heterogeneous nodule echo,boundary characteristics,CT diagnosis and pathological diagnosis.Logistic regression analysis and receiver operating characteristic curvecurve(ROC)curve were used.To investigate the diagnostic value of R-EBUS imaging features in peripheral lung cancer.Results Sixty-six cases(68.75%)showed homogeneous solid echogenicity,30 cases(43.48%)showed heterogeneous solid echogenicity,57 cases(59.38%)showed clear border,and 39 cases(40.62%)showed unclear border.67 cases(69.79%)of lung cancer and 29 cases(30.21%)of other non-neoplastic diseases were diagnosed by spiral CT before operation.58 cases(60.42%)of lung tumors were diagnosed by histopathology,including 39 cases(40.63%)of adenocarcinoma,9 cases(9.38%)of squamous cell carcinoma and 10 cases(10.42%)of other tumors.There were 38 cases(39.58%)of non-tumor diseases diagnosed by histopathology,including 24 cases(25.00%)of inflammation,6 cases(6.25%)of focal granulomatous inflammation or tuberculosis,and 8 cases(8.33%)of other non-tumor diseases.There were 51 cases of lung cancer(53.13%)and 15 cases of non-lung cancer(15.63%)with homogeneous echo and histopathologic diagnosis,7 cases of lung cancer(7.29%)and 23 cases of non-lung cancer(23.96%)with heterogeneous echo.Homogeneous echo was correlated with pathological diagnosis of lung cancer(P<0.001).The sensitivity and specificity of echo diagnosis of lung cancer were 87.93%and 60.53%,respectively.Borderless and histopathologically diagnosed were lung cancer in 24 cases(25.00%)and non-lung cancer in 34 cases(35.41%).Borderless and histopathologically diagnosed were lung cancer in 15 cases(15.63%)and non-lung cancer in 23 cases(23.96%).There was no correlation between boundary features and pathological diagnosis of lung cancer(P>0.05).Logistic regression analysis showed that echo,CT and echo combined with CT detection were consistent with pathological diagnosis of lung cancer(P<0.001).ROC curve analysis showed that echo AUC:0.7423,CTAUC:0.7945,and echo combined with CTAUC:0.8827.Conclusion The solid homogeneous echo in R-EBUS image is significantly correlated with the pathological diagnosis of lung cancer.R-EBUS combined with CT can improve the diagnostic accuracy of lung cancer.