Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions

Beilei GONG; Wei LI; Yuqing CHEN; Hua GAO; Xueying CHEN; Cuixia LI

doi:10.16016/j.1000-5404.201704123

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Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions

Clinical Medicine | 更新时间：2026-01-09

- Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions
- Journal of Third Military Medical University Vol. 39, Issue 17, Pages: 1756-1761(2017)
- 作者机构：
  
  233000 安徽蚌埠, 安徽省蚌埠医学院第一附属医院呼吸与危重症医学科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81172213);the General Program of Natural Science Foundation of Anhui Province(1408085MH14)
- DOI：10.16016/j.1000-5404.201704123
  CLC： R445.1;R563.04;R768.1
- Received：25 April 2017，
  
  Revised：2017-07-11，
  
  Published：15 September 2017
- 稿件说明：
移动端阅览
Beilei GONG, Wei LI, Yuqing CHEN, et al. Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions[J]. Journal of Third Military Medical University, 2017, 39(17): 1756-1761.
DOI：

Beilei GONG, Wei LI, Yuqing CHEN, et al. Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions[J]. Journal of Third Military Medical University, 2017, 39(17): 1756-1761. DOI： 10.16016/j.1000-5404.201704123.

摘要

目的

探讨气道内径向超声(radial endobronchial ultrasound

R-EBUS)引导下经支气管镜检查在诊断周围性肺部病变(peripheral pulmonary lesions

PPLs)中的应用价值

评估其诊断成功率、安全性及影响因素。

方法

回顾性分析2015年1月至2017年3月在我院呼吸内镜室行径向超声引导下经支气管镜活检(R-EBUS transbronchial biopsy

R-EBUS TBB)和刷检的140例患者的临床资料

筛选出83例PPLs患者

观察EBUS对病变的定位能力

分析其诊断成功率及影响因素

观察有无并发症

进行安全性评估。

结果

83例患者中男性55例

女性28例

年龄(59.81±11.85) 岁。R-EBUS引导下经支气管镜检查总诊断成功率59.04 %(49/83)

其中肺恶性病变诊断率50.94%(27/53)

非恶性病变诊断率73.33%(22/30)；R-EBUS TBB诊断率(56.92%

37/65) 高于经支气管镜刷检诊断率(30.12%

25/83)(

=10.76

=0.001)；支气管镜下超声引导联合测量技术(EBUS-D)诊断率为60.00%(45/75)

经导向鞘引导的超声支气管镜(EBUS-GS)诊断率为50.00%(4/8)

二者相比差异无统计学意义(

=0.03

=0.87)。病灶直径10.0~52.4 mm

其中直径≤20 mm者诊断率(36.84%

7/19) 低于直径＞20 mm者(65.62%

42/64)(

=5.02

=0.03)；各叶段病灶诊断率分别为右上叶46.15%(12/26)

右中叶100.00%(8/8)

右下叶53.85%(7/13)

左上叶固有段37.50%(3/8)

左上叶舌段63.64%(7/11)

左下叶70.59%(12/17)

差异无统计学意义(

=10.05

=0.07)；而上叶(22/45

48.89%)诊断率低于中/下叶(27/38

71.05%)(

=4.18

=0.04)。R-EBUS明确病变位置者74例(89.16 %

74/83)

9例超声下未发现目标病变

超声探头位于病变区域内者诊断率(81.58%

31/38) 明显高于病变偏离探头者(50.00%

18/36)(

=8.24

=0.004)。并发症仅为经气管镜取材部位少量出血

无气胸等的发生。

结论

R-EBUS可准确定位肺部周围性病变

提高PPLs的诊断率

安全可行；EBUS-D对PPLs诊断具有较高阳性率

且节约成本；病灶大小、径向超声探头与靶病变的位置关系是影响其诊断率的主要因素。

Abstract

Objective

To investigate the application of radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs)

assess its safety and diagnostic value

and explore the influencing factors.

Methods

Clinical data of 140 patients who underwent R-EBUS transbronchial biopsy (TBB) and brush biopsy in our department of respiratory endoscopy from January 2015 to March 2017 were collected and retrospectively analyzed in the study. Eighty-three cases were diagnosed as PPLs. The detection rate

ability to locate the peripheral lesions

and influencing factors of EBUS were analyzed. The incidence rate of complications was observed to assess its safety.

Results

Of the 83 PPLs patients

they were 55 males and 28 females

and at a mean age of 59.81±11.85 years. The total success rate of EBUS-guided bronchoscopic diagnosis was 59.04% (49/83)

and the diagnostic rate was 50.94% (27/53) for malignant lesions

and 73.33% (22/30) for benign diseases. The rate of EBUS-TBB (56.92%

37/65) was significantly higher than that of brush biops

y (30.12%

25/83

Chi

square=10.76

=0.001). EBUS-guided diagnostic methods had an accuracy of 60.00% (45/75)

while the EBUS-guided bronchoscopy had a rate of 50.0% (4/8)

but no significant difference was seen between the 2 methods (

Chi

square=0.03

=0.87).The sizes of the lesions ranged from 10.0 to 52.4 mm

and the diagnostic yield for PPLs ≤20 mm in diameter (36.84%

7/19) was lower than that for those

20 mm (65.62%

42/64

Chi

square=5.02

=0.003). There was no significant difference (

Chi

square=10.05

=0.07) in the diagnostic yield for different sites

with that of right upper lobe of 46.15% (12/26)

right middle lobe 100.00%(8/8)

right lower lobe 53.85%(7/13)

left upper lobe 37.50%(3/8)

left lingula lobe 63.64%(7/11)

left lower lobe 70.59% (12/17). But the detection rate was obviously lower in the upper lobe (22/45

48.89%) than the middle/lower lobe (27/38

71.05%

Chi

square=5.02

=0.003). Of all the 83 patients

74 ones (89.16%) were successfully identified using radial probe EBUS

but the lesions were not found in 9 patients. When the radial probe position was within the target lesion

the diagnostic yield was 81.58% (31/38)

notably higher than that when the probe was positioned adjacent to the lesion (50.00%

18/36

Chi

square=8.24

=0.004). Mild bleeding was observed when performing biopsy under bronchoscope

and no pneumothorax

or other serious complications were observed.

Conclusion

Radial EBUS is a safe and feasible method to accurately identify PPLs and improve its diagnostic rate. EBUS-guided bronchoscopy has higher positive detection rate for PPLs

and is cost saving. The relationship of the probe and the site of lesion is the main factor influencing the diagnostic rate.

关键词

Keywords

references

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