超声引导下经支气管镜检查在周围性肺部病变诊断中的应用

宫蓓蕾; 李伟; 陈余清; 高华; 陈雪英; 李翠侠

doi:10.16016/j.1000-5404.201704123

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超声引导下经支气管镜检查在周围性肺部病变诊断中的应用

临床医学 | 更新时间：2026-01-09

- 超声引导下经支气管镜检查在周围性肺部病变诊断中的应用
- Radial probe endobronchial ultrasound-guided bronchoscopy for peripheral pulmonary lesions
- 第三军医大学学报 2017年39卷第17期页码：1756-1761
- 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：
  
  [李伟, E-mail：bbmcliwei@126.com LI Wei, E-mail: bbmcliwei@126.com
- 基金信息：
  
  国家自然科学基金面上项目(81172213);安徽省自然科学基金面上项目(1408085MH14)
- DOI：10.16016/j.1000-5404.201704123
  中图分类号： R445.1;R563.04;R768.1
- 收稿：2017-04-25，
  
  修回：2017-07-11，
  
  纸质出版：2017-09-15
- 稿件说明：
移动端阅览
宫蓓蕾, 李伟, 陈余清, 等. 超声引导下经支气管镜检查在周围性肺部病变诊断中的应用[J]. 第三军医大学学报, 2017,39(17):1756-1761.

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.
宫蓓蕾, 李伟, 陈余清, 等. 超声引导下经支气管镜检查在周围性肺部病变诊断中的应用[J]. 第三军医大学学报, 2017,39(17):1756-1761. DOI： 10.16016/j.1000-5404.201704123.

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

DHOORIA S, SEHGAL I S, GUPTA N, et al. Role of radial endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of pulmonary nodules: case report and literature review[J]. Lung India: official organ of Indian Chest Society, 2017, 34(1): 61. DOI: 10.4103/0970-2113.197094.

WANG C, LI X, ZHOU Z, et al. Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis[J]. J Thorac Dis, 2016, 8(10): 2758-2764. DOI:10. 21037/jtd.2016.09.52.

ZARIC B, STOJSIC V, CARAPIC V, et al. Radial endobronchial ultrasound (EBUS) guided suction catheter-biopsy in histological diagnosis of peripheral pulmonary lesions[J]. J Cancer, 2016, 7(1): 7-13. DOI:10.7150/jca.13081.

KUO C H, LIN S M, LEE K Y, et al. Endobronchial ultrasound-guided transbronchial biopsy and brushing: a comparative evaluation for the diagnosis of peripheral pulmonary lesions[J]. Eur J Cardiothorac Surg, 2014, 45(5): 894-898. DOI:10.1093/ejcts/ezt472.

FUSO L, VARONE F, MAGNINI D, et al. Role of ultrasound-guided transbronchial biopsy in the diagnosis of peripheral pulmonary lesions[J]. Lung Cancer, 2013, 81(1): 60-64. DOI:10.1016/j.lungcan.2013.04.004.

HAYAMA M, OKAMOTO N, SUZUKI H, et al. Radial endobronchial ultrasound with a guide sheath for diagnosis of peripheral cavitary lung lesions: a retrospective study[J]. BMC Pulm Med, 2016, 16(1): 76. DOI:10.1186/s12890-016-0244-y.

CHAVEZ C, SASADA S, IZUMO T, et al. Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations[J]. J Thorac Dis, 2015, 7(4): 596-602. DOI:10.3978/j.issn.2072-1439.2015.03.04.

HIBARE K R, GOYAL R, NEMANI C, et al. Radial endobronchial ultrasound for the diagnosis of bronchoscopically invisible lesions: First case series from India[J]. Lung India, 2017, 34(1): 43-46. DOI:10.4103/0970-2113.197100.

TAY J H, IRVING L, ANTIPPA P, et al. Radial probe endobronchial ultrasound: factors influencing visualization yield of peripheral pulmonary lesions[J]. Respirology, 2013, 18(1): 185-190. DOI:10.1111/j.1440-1843.2012.02276.x.

YOSHIKAWA M, SUKOH N, YAMAZAKI K, et al. Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without X-ray fluoroscopy[J]. Chest, 2007, 131(6): 1788-1793. DOI:10. 1378/chest.06-2506.

IZUMO T, SASADA S, CHAVEZ C, et al. The diagnostic value of histology and cytology samples during endobronchial ultrasound with a guide sheath[J]. Jpn J Clin Oncol, 2015, 45(4): 362-366. DOI:10.1093/jjco/hyv004.

HAYAMA M, IZUMO T, MATSUMOTO Y, et al. Complications with endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions[J]. Respiration, 2015, 90(2): 129-135. DOI:10.1159/000431383.

CHAN A, DEVANAND A, LOW S Y, et al. Radial endobronchial ultrasound in diagnosing peripheral lung lesions in a high tuberculosis setting[J]. BMC Pulm Med, 2015, 15(1). DOI:10.1186/s12890-015-0089-9.

潘文森, 于婧, 刘欣, 等.气管内超声结合引导鞘管对于肺部周边病变诊断的研究[J].中华超声影像学杂志, 2015, 24(6): 543-545. DOI:10.3760/cma.j.issn.1004-4477.2015.06. 026.

PAN W S, YU J, LIU X, et al. Diagnosis of pulmonary peripheral lesions by intrauterine ultrasound combined with guided sheath [J]. Chin J Ultrasonogr, 2015, 24(6): 543-545. DOI:10.3760/cma.j.issn.1004-4477.2015.06.026.

CASUTT A, PRELLA M, BEIGELMAN-AUBRY C, et al. Fluoroscopic-guided radial endobronchial ultrasound without guide sheath for peripheral pulmonary lesions: a safe and efficient combination[J]. Arch Bronconeumol, 2015, 51(7): 338-343. DOI:10.1016/j.arbres.2014.09.017.

SCHUHMANN M, BOSTANCI K, BUGALHO A, et al. Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: a feasibility study[J]. Eur Respir J, 2014, 43(1): 233-239. DOI:10.1183/09031936.0001 1313.

李明, 彭爱梅, 张国良, 等.支气管超声下经引导鞘肺活检术诊断肺周围性病变的价值[J].中华结核和呼吸杂志, 2014, 37(1): 36-40. DOI:10.3760/cma.j.issn.1001-0939.2014.01.010.

LI M, PENG A M, ZHANG G L, et al. Endobronchial ultrasound transbronchial lung biopsy with guide-sheath for the diagnosis of peripheral pulmonary lesions[J]. Chin J Tuber Respir Dis, 2014, 37(1): 36-40. DOI:10.3760/cma.j.issn.1001-0939.2014.01.010.

EBERHARDT R, ANANTHAM D, ERNST A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial[J]. Am J Respir Crit Care Med, 2007, 176(1): 36-41. DOI:10.1164/rccm.200612-1866OC.

GEX G, PRALONG J A, COMBESCURE C, et al. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis[J]. Respiration, 2014, 87(2): 165-176. DOI:10.1159/000355710.

SEIJO L M. Electromagnetic navigation bronchoscopy: clinical utility in the diagnosis of lung cancer[J]. Lung Cancer (Auckl), 2016, 7: 111-118. DOI:10.2147/LCTT.S98643.

GODBOUT K, MARTEL S, SIMON M, et al. Evaluation of pulmonary nodules using the spyglass direct visualization system combined with radial endobronchial ultrasound: a clinical feasibility study[J]. Open Respir Med J, 2016, 10(1): 79-85. DOI:10.2174/1874306401610010079.

IZUMO T, SASADA S, CHAVEZ C, et al. The diagnostic utility of endobronchial ultrasonography with a guide sheath and tomosynthesis images for ground glass opacity pulmonary lesions[J]. J Thorac Dis, 2013, 5(6): 745-750. DOI:10.3978/j.issn.2072-1439.2013.11.30.

IKEZAWA Y, SHINAGAWA N, SUKOH N, et al. Usefulness of endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation for ground-glass opacity lesions[J]. Ann Thorac Surg, 2017, 103(2): 470-475. DOI:10. 1016/j.athoracsur.2016.09.001.

ALI M S, TRICK W, MBA B I, et al. Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis[J]. Respirology, 2017, 22(3): 443-453. DOI:10.1111/resp.12980.

SHEPHERD R W. Bronchoscopic pursuit of the peripheral pulmonary lesion: navigational bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy[J]. Curr Opin Pulm Med, 2016, 22(3): 257-264. DOI:10.1097/MCP.0000000000000273.

KATSURADA M, IZUMO T, NAGAI Y, et al. The dose and risk factors for radiation exposure to medical staff during endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions under X-ray fluoroscopy[J]. Japanese Journal of Clinical Oncology, 2014, 44(3): 257-262. DOI:10.1093/jjco/hyt224.

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