The clinical application of endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective,a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan (≥ 1. 0 cm) . Results Of the 52 patients,41 patients were found with N2 or N3 disease

Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.AIM To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.METHODS This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy.The specimens were defined as positive for malignancy,negative for non-malignancy(tuberculosis,sarcoidosis,etc.),and without a definitive diagnosis.Sensitivity,negative predictive value(NPV)for malignancy,and overall accuracy were calculated.Complications were recorded.RESULTS A total of 80 patients underwent EBUS-TBNA and had a final diagnosis,among which 50(62.5%)were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis,14(17.5%)were diagnosed with primary lung cancer with nodal involvement,and 16(20.0%)exhibited benign behavior including tuberculosis,sarcoidosis and reactive lymphadenitis or who had benign follow-up.The diagnostic sensitivity,NPV,and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8%(n=60/64),80.0%(n=16/20),and 95.0%(n=76/80),respectively.In the multivariate analysis,longer short axis of the lymph node(OR:1.200,95%CI:1.024-1.407;P=0.024)and synchronous lung lesion(OR:19.449,95%CI:1.875-201.753;P=0.013)were independently associated with malignant intrathoracic lymphadenopathy.No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy,and no major complication was observed.CONCLUSION EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis： A Meta-analysis

Background： Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods. Methods： We searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 （Nordic Cochrane Center, Copenhagen, Denmark） and Stata 12.0 software （Stata Corporation, College Station, TX, USA）. The Mantel-Haenszel method was used to calculate the pooled odds ratio （OR） and 95% confidence intervals （Cls）. Results： Sixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy （TBLB） for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 （95% CI, 2.20-15.79, P = 0.0004）. These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA ＋ TBLB ＋ endobronchial biopsy （EBB） versus TBNA ＋ TBLB ＋ EBB was 1.54 （95% C1, 0.61-3.93, P = 0.36）, implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables. Conclusions： The results of this meta-analysis suggest that EBUS-TBNA ＋ TBLB ＋ EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA ＋ TBLB ＋ EBB could be used instead.

Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed mediastinal lymphadenopathy

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions

Background Mediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities. Methods We retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People＇s Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out. Results Endobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.

First 30 endobronchial ultrasound-guided transbronchial needle aspirations： a single institution＇s early experience

Background A new technique developed in 2002, aspiration （EBUS-TBNA）, has been one of the most real time endobronchial ultrasound-guided transbronchial needle important tools in lymph nodes （LNs） staging before lung cancer surgery. EBUS-TBNA was introduced into China in 2008. Methods Between June 2009 and October 2009, 30 patients with mediastinal/hilar lymphadenopathy and thoracic masses previously detected with CT scan underwent EBUS-TBNA without rapid onsite cytological examination. Results From 30 patients, 33 samples were obtained from LNs and seven samples from intrapulmonary lesions. Twenty out of the 23 lung cancer diagnoses were clarified through the procedure, with sensitivity, specificity, positive predictive value, negative predictive value and accuracy being 87%, 100%, 100%, 70% and 90%, respectively. All three false negative cases were found in the first five procedures. Additionally, among the 33 LNs examined, three specimens that had no lymphocytes were also found within the first five procedures. There were no major complications, and the procedures were uneventful. Conclusions EBUS-TBNA seems a safe and effective technique in making diagnosis for mediastinal/hilar LNs and intrapulmonary masses. For pulmonologists experienced in bronchoscopy, the sensitivity of the procedure for diagnosing lung cancer should be no less than 90% after the initial five procedures.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Increases the Yield of Transbronchial Lung Biopsy for the Evaluation of Peribronchial Lesions

Background： Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound （CP-EBUS） has allowed for performing real-time transbronchial needle aspiration （TBNA） of enlarged hilar and mediastinal lymph nodes and therefore could also be used as a means of diagnosing proximal peribronchial lesions. Methods： We retrospectively analyzed the results related to 72 patients who underwent CP-EBUS for peribronchial lesions without endobronchial involvement and adjacent to three-grade bronchi based on chest computed tomography （CT） scan. We recorded the images during EBUS as well as the diagnostic results of TBNA and conventional-transbronchial lung biopsy/brush （C-TBLB/b）, and final diagnoses were based on pathologic analysis and follow-up. Results： In all cases, the mass was able to be identified using EBUS in 97.2% patients （70/72） who were performed with EBUS-TBNA ＋ C-TBLB/b. Sixty-six patients had a final diagnosis, 80.0% patients （56/70） had malignancies, and 14.3% patients （10/70） had benign disease. In malignancies, the diagnostic yield of C-TBLB/b was 57.1% （32/56） and in EBUS-TBNA was 85.7% （48/56）, whereas pathologic diagnosis reached 94.6% when EBUS-TBNA was combined with C-TBLB/b. C-TBLB/b ＋ EBUS-TBNA also exhibited stronger potency of histolytic diagnosis for malignancies than either EBUS-TBNA or C-TBLB/b alone. Furthermore, there are data supporting the value of EBUS-TBNA for the diagnosis of benign lung disease. Conclusion： The combined endoscopic approach with EBUS-TBNA and C-TBLB/b is an accurate and effective method for the evaluation of peribronchial lesions, with better results than using each technique alone.

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in intrapulmonary lesions

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway. Methods From September 2009 to March 2013, 66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA. Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a surgical procedure. ResuLts Among the 66 cases, 59 were confirmed as pulmonary malignancies by EBUS-TBNA, of which 48 cases were non-small cell lung cancer, nine were small cell lung cancer, and two were metastatic lung tumors. No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases. Thoracoscopy or thoracotomy was subsequently undergone for them. Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung, one case of lymphoma, two cases of sclerosing hemangioma, and one case of pulmonary tuberculoma. The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%, 100.0%, and 93.9%, respectively. The positive and negative predictive values were 100.0% and 42.9%, respectively. The EBUS-TBNA procedures were well-tolerated by all patients. No associated complications were observed. Conclusions For intrapulmonary lesions near the central airway highly suspected of cancer, EBUS-TBNA has satisfactory diagnostic value. However, the negative predictive value of this technique is low, so negative results obtained by EBUSTBNA should be confirmed by other methods.

Value of virtual bronchoscopic navigation and transbronchial ultrasound-guided sheath-guided exploration in diagnosis of peripheral lung cancer

BACKGROUND Peripheral lung cancer poses a substantial harm to human health,and it is easy to become exacerbated,potentially threatening the life and safety of patients AIM To assess the value of virtual bronchoscopic navigation(VBN)combined with transbronchial ultrasound-guided sheath-guided(EBUS-GS)exploration in the diagnosis of peripheral lung cancer.METHODS A total of 236 patients with peripheral lung cancer(nodule diameter range,8-30 mm;diagnosed using high-resolution computed tomography)were selected from three centers between October 2018 and December 2019.Patients who underwent EBUS-GS exploration alone were included in a control group,and those who received VBN in combination with EBUS-GS exploration were included in an observation group.The diagnostic rate and total operating time of differentsubgroups of the two groups were compared,and the time needed to determine the lesion was recorded.RESULTS There were no significant differences in diagnosis rate or total operation time between the two groups(P>0.05),and the time needed to determine the lesion in the observation group was less than that of the control group(P<0.05).CONCLUSION The combined use of VBN and EBUS-GS exploration technology has little effect on the diagnosis rate and total operation time of peripheral lung cancer,but it significantly shortens the time needed to determine the lesion and is a valuable diagnostic method.

Accuracy of endoscopic ultrasound-guided needle aspiration specimens for molecular diagnosis of non-small-cell lung carcinoma

BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)are highly sensitive for diagnosing and staging lung cancer.In recent years,targeted therapy has shown great significance in the treatment of non-small cell lung carcinoma(NSCLC).Using these minimally invasive techniques to obtain specimens for molecular testing will provide patients with a more convenient diagnostic approach.AIM To evaluate the feasibility and accuracy of tissue samples obtained using EUSFNA and EBUS-TBNA for molecular diagnosis of NSCLC.METHODS A total of 83 patients with NSCLC underwent molecular testing using tissues obtained from EUS-FNA or EBUS-TBNA at the Tianjin Medical University Cancer Hospital from January 2017 to June 2019.All enrolled patients underwent chest computed tomography or positron emission tomography/computed tomography prior to puncture.We detected abnormal expression of EGFR,KRAS,MET,HER2,ROS1 and anaplastic lymphoma kinase protein.Two patients failed to complete molecular testing due to insufficient tumor tissue.The clinical features,puncture records,molecular testing results and targeted treatment in the remaining 81 patients were summarized.RESULTS In a total of 99 tissue samples obtained from 83 patients,molecular testing was successfully completed in 93 samples with a sample adequacy ratio of 93.9%(93/99).Biopsy samples from two patients failed to provide test results due to insufficient tumor tissue.In the remaining 81 patients,62 cases(76.5%)were found to have adenocarcinoma,11 cases(13.6%)had squamous cell carcinoma,3 cases(3.7%)had adenosquamous carcinoma and 5 cases(6.2%)had NSCLC-not otherwise specified.The results of molecular testing showed EGFR mutations in 21 cases(25.9%),KRAS mutations in 9 cases(11.1%),ROS-1 rearrangement in 1 case(1.2%)and anaplastic lymphoma kinase-positive in 5 cases(6.2%).Twentyfour patients with positive results received targeted therapy.The total effectiveness rate of targeted therapy was 66.7%(16/24),and the disease control rate was 83.3%(20/24).CONCLUSION Tissue samples obtained by EUS-FNA or EBUS-TBNA are feasible for the molecular diagnosis of NSCLC and can provide reliable evidence for clinical diagnosis and treatment.

Training benefits of virtual bronchoscopy prior to Endobronchial Ultrasound Guide sheath

Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bron- choscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation. Results: From 7 archived cases, 14 doctors identified the correct bronchus in 94 of 98 assessments (95%). Percentage of cases where there was an improvement in localisation by 2 or more 4th order bronchi was 39.8% overall (28.6% – 51.0%), 26.6 for experienced and 53.1 for inexperienced bronchoscopists (p < 0.02). The absolute mean number of 4th order bronchi different between CT and VBNS was 2.0 ± 2.6 overall, 1.2 (range 0-6) for experienced, and 2.8 (range 0-11) for inexperienced bronchoscopists. Virtual Path software calculation time was 8.1 ± 2.7 minutes, compared to 3.6 ± 2.1 minutes by CT. Conclusion: VBNS allowed rapid accurate assessment with minimal software training. Greatest benefits in reduction of procedure time were obtained in inexperienced bronchoscopists, and VBNS could allow more rapid skill development in EBUS GS in these doctors.

Diagnostic value of endobronchial ultrasound guided transbronchial needle aspiration in superior vena cava syndrome

Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome （SVCS）.The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA）.Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed.Of these,there were 14 males and 6 females （mean age of 59.1 years） with SVCS who received EBUS-TBNA that were included in the analysis.Results The mean short axis diameter of the paratracheal lesions was （3.32±1.79） cm （range,1.69 to 9.50 cm） and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of （2.14±0.49） cm （range,1.73 to 3.01 cm）.An average of 4.3 punctures was performed per lesion.Malignancy was confirmed in 16 cases （10 small cell carcinomas,4 adenocarcinomas,1 squamous cell carcinoma and 1 Hodgkin lymphoma）.In two patients,pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up.One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC.One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin＇s lymphoma.The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.

快速现场评价联合支气管内超声引导下经支气管镜肺活检对肺外周恶性肿瘤的诊断价值

目的:探讨快速现场评价(ROSE)联合支气管内超声引导下经支气管镜肺活检(EBUS-TBLB)在诊断肺外周恶性肿瘤中的临床价值。方法:回顾性分析2021年1月至2022年6月在广州医科大学附属第一医院国家呼吸医学中心行EBUS-TBLB检查的肺外周病灶直径≤30 mm的患者190例,根据是否进行ROSE检查,分为ROSE组(50例)和非ROSE组(140例),比较两组的总体诊断率,并分析病灶所在肺叶位置、病灶直径、超声探头在病灶中的位置以及病灶距胸膜的距离等因素对两组患者诊断率的影响。结果:ROSE联合EBUS-TBLB可提高肺外周恶性肿瘤的诊断率(84.00%比60.71%,P=0.003)。在直径21~30 mm的病灶中,ROSE组的诊断率显著高于非ROSE组(85.29%比64.13%,P=0.022)。ROSE可明显提高超声图像显示病变包绕超声探头的肿瘤病灶的诊断率(90.32%比62.34%,P=0.004)。在距离胸膜≤15 mm的病灶中,ROSE组的诊断率明显高于非ROSE组(95.24%比60.76%,P=0.003)。结论:ROSE可显著提高EBUS-TBLB对肺外周恶性肿瘤的诊断率,在直径21~30 mm、超声影像中间型以及距离胸膜≤15mm的病灶中有更明显的优势。

经皮二氧化碳分压监测在硬质支气管镜下Feng′s EBUS-TBNB中的应用

目的:探讨经皮二氧化碳分压(transcutaneous partial pressure of carbon dioxide,PtcCO_(2))监测在硬质支气管镜下冯氏气管内超声引导纵隔切开活检(Feng′s endobronchial ultrasound-guided transbronchial node biopsy,Feng′s EBUS-TBNB)中的应用。方法:收集2019年8月—2022年8月期间天津医科大学总医院收治的纵隔疾病患者128例,随机分成Feng′s EBUS-TBNB组和支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)组,患者均予高频喷射通气行硬质支气管镜下操作及PtcCO_(2)监测,EBUS-TBNA组患者行EBUS-TBNA,Feng′s EBUS-TBNB组患者行Feng′s EBUS-TBNB术,比较两组患者术前(T0)、通气开始时(T_(1))、通气10 min后(T_(2))、通气20 min后(T3)、通气30 min后(T_(4))、通气40 min后(T_(5))、通气50 min后(T_(6))、通气60 min后(T_(7))心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和PtcCO_(2)的变化。结果:T_(1)~T_(7)时,两组患者HR、MAP和PtcCO_(2)水平均明显高于T0时(P<0.05)。T0~T_(2)时,两组患者HR、MAP和PtcCO_(2)水平比较差异无统计学意义(P>0.05);T3~T_(5)时,Feng′s EBUS-TBNB组HR、MAP和PtcCO_(2)水平均明显高于EBUS-TBNA组(P<0.05);而T_(6)~T_(7)时,两组患者HR、MAP和PtcCO_(2)水平比较差异无统计学意义(P>0.05)。结论:将PtcCO_(2)应用于Feng′s EBUS-TBNB中,可间接反映患者HR、MAP水平变化,值得临床推广应用。

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

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。

不同经支气管镜活检术在老年中央型肺癌诊断中的应用

目的 研究不同经支气管镜活检术在老年中央型肺癌诊断中的应用价值。方法 回顾性分析2020年6月至2023年6月中国人民解放军联勤保障部队第九二三医院收治的97例经病理学确诊为中央型肺癌的老年患者的临床资料。根据首次经纤维支气管镜活检方式的不同,将患者分为支气管内膜活检术(EBB)组(n=51)和常规经支气管镜针吸活检术(cTBNA)组(n=46)。统计组织病理学结果,计算并对比EBB、cTBNA在诊断老年中央型肺癌中的首次活检阳性率,同时评价2组患者活检耐受度及并发症的差异。结果 2组患者鳞癌占比均超过50%,2组患者的首次活检阳性率比较,差异无统计学意义(P>0.05)。EBB组患者术中因主观耐受度导致临时退镜发生率高于cTBNA组,差异有统计学意义(P<0.05)。2组患者术中不同级别并发症的发生率比较,差异具有统计学意义(P<0.001),其中EBB组患者术中2级及以上并发症发生率显著高于cTBNA组(P<0.001)。结论 对于老年中央型肺癌患者,EBB与cTBNA的首次活检阳性率大致相当,但后者术后并发症发生率显著低于前者,可将cTBNA作为该人群首选活检方式。

全身麻醉及现场快速评价在EBUS-TBNA诊断肺癌中的价值

背景与目的肺癌是常见的呼吸系统恶性肿瘤。超声引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)是诊断肺癌和评估分期的重要工具。EBUS-TBNA大多在局部麻醉或清醒镇静下进行,而在全身麻醉下行EBUS-TBNA以及同时应用快速现场评价(rapid on-site evaluation,ROSE)能否进一步提高诊断效能目前仍未可知,本研究拟探索全身麻醉及ROSE在EBUS-TBNA诊断肺癌中的价值。方法回顾性分析164例于2018年1月至2022年12月于西南医科大学附属医院呼吸与危重医学科就诊患者的资料,所有患者术前均疑诊为肺癌并行EBUS-TBNA,根据是否行全身麻醉及ROSE将患者分为局麻组(n=54)、全麻组(n=67)和全麻ROSE组(n=43),分析各组的穿刺情况以及在疾病诊断方面的差异。结果局麻组的淋巴结穿刺针数高于全麻ROSE组(P<0.01)。三组患者的疾病总诊断率分别为87.04%、89.55%和90.70%,恶性肿瘤的诊断率分别为88.24%、88.89%和94.74%,均无统计学差异(P>0.05)。三组中没有患者出现严重并发症及麻醉相关不良反应。结论与局部麻醉联合静脉镇痛镇静相比,全身麻醉下实施EBUS-TBNA无论是否联合ROSE均可得到同样准确的结果,全身麻醉联合ROSE可以减少淋巴结穿刺针数。

快速现场评估联合径向支气管超声肺活检对老年周围型肺部病变的诊断价值

目的 探讨快速现场评估(ROSE)联合径向支气管超声肺活检(EBUS-TBLB)对老年病人周围型肺部病变(PPLs)的诊断价值。方法 选择112例经胸部CT发现有未确诊的老年PPLs病人纳入本研究。所有病人均接受了EBUS-TBLB检查,并从每次操作中获得活检标本,进行ROSE,将ROSE诊断结果与最终病理诊断结果进行比较,记录ROSE阳性组及阴性组的操作时间、操作次数,分析ROSE联合EBUS-TBLB在老年病人PPLs诊断中的可行性和安全性。结果 ROSE联合EBUS-TBLB对老年病人PPLs的诊断准确度、敏感度和特异度分别为90.2%、86.7%和97.3%。ROSE阳性病人的活检次数和操作时间均少于ROSE阴性病人(P<0.05)。所有病人均无严重的手术并发症发生。结论 ROSE联合EBUS-TBLB是一种安全有效诊断老年病人PPLs的方法。

快速现场评价技术指导宏基因组二代测序技术在肺部疑诊结节病中应用研究

目的探讨快速现场评价(ROSE)技术指导宏基因组二代测序技术(mNGS)在肺部疑诊结节病中的应用价值。方法选取自2022年1月至12月经胸部计算机断层扫描发现存在肺门和(或)纵隔淋巴结肿大且临床疑诊结节病而行支气管内超声引导下经支气管针吸活检(EBUS-TBNA)的96例患者为研究对象。根据是否行ROSE技术将患者分为ROSE组(n=42),非ROSE组患者(n=54),分析两组患者的穿刺针数、mNGS送检率、mNGS阳性率、非合格标本占比、诊断率等。结果ROSE组穿刺次数为(2.73±1.15)次,略高于非ROSE组的(2.44±1.06)次,但两组间比较,差异无统计学意义(P>0.05)。ROSE组mNGS送检率为83.3%(35/42),明显低于非ROSE组的98.1%(53/54),差异有统计学意义(P<0.05)。ROSE组非合格标本占比为11.9%(5/42),明显低于非ROSE组的31.5%(17/54),差异有统计学意义(P<0.05)。ROSE组的诊断率为81.0%(34/42),明显高于非ROSE组的59.3%(32/54),差异有统计学意义(P<0.05)。ROSE组mNGS阳性率为34.0%(12/35),高于非ROSE组的26.0%(14/53),但两组间比较,差异无统计学意义(P>0.05)。结论在肺部疑诊结节病需行EBUS-TBNA患者中,通过ROSE技术指导是否送检mNGS,可以降低mNGS送检率,降低非合格标本占比,提高诊断率。

雾化超微粒径盐酸戊乙奎醚在喉罩全麻患者EBUS-TBNA术中的临床研究

目的观察雾化吸入超微粒径盐酸戊乙奎醚(PHC)对超声引导下经支气管针吸活检(EBUS-TBNA)患者喉罩全麻后气道损伤的影响,并分析其作用机制。方法选取河南省人民医院2021年1月至2022年1月收治的126例行EBUS-TBNA的喉罩全麻患者进行随机对照试验,以随机数字表法将其分为观察组和对照组,各63例。观察组男33例,女30例,年龄38~72(55.62±5.69)岁,采用经雾化吸入超微粒径PHC辅助喉罩全麻;对照组男32例,女31例,年龄40~70(56.33±5.25)岁,采用二羟丙茶碱注射液辅助喉罩全麻。比较两组患者治疗前后的炎症指标、气道形态学指标、通气功能变化情况,以及术后气道损伤发生情况。采用t检验、χ^(2)检验。结果术后,观察组的白细胞介素-13(IL-13)、肿瘤坏死因子-α(TNF-α)、呼出气一氧化氮(FeNO)均低于对照组[(6.13±2.21)ng/L比(8.33±2.45)ng/L、(7.22±2.15)ng/L比(9.36±2.77)ng/L、(23.32±2.17)ppb比(26.61±5.41)ppb],差异均有统计学意义(t=5.29、4.84、4.48,均P<0.05)。术后,观察组的支气管基底膜周径(Pbm)、气道壁总厚度、气道平滑肌厚度均低于对照组[(1.77±0.24)cm比(2.16±0.38)cm、(7.15±2.41)mm^(2)/mm比(9.24±2.25)为mm^(2)/mm、(3.44±0.58)mm^(2)/mm比(4.41±1.27)mm^(2)/mm],差异均有统计学意义(t=6.89、5.03、5.52,均P<0.05)。术后,观察组的第一秒用力呼气量(FEV1)、呼气流量峰值(PEF)、用力肺活量(FVC)均高于对照组[(85.22±10.46)%比(78.25±10.13)%、(422.74±80.61)L/min比(378.25±80.24)L/min、(2.68±0.46)L比(1.92±0.74)L],差异均有统计学意义(t=3.80、3.11、6.92,均P<0.05)。术后,观察组的气道损伤发生率低于对照组[9.52%(6/63)比20.63%(13/63)],差异有统计学意义(χ^(2)=4.82,P<0.05)。结论雾化吸入超微粒径PHC辅助喉罩全麻能有效改善EBUS-TBNA患者术后气道炎症反应及通气功能,其机制考虑与抑制气道平滑肌增殖、促进气道形态学恢复相关。