Clinical study on diagnosis of peripheral lung cancer with virtual bronchoscopic navigation combined with endobronchial ultrasonography with a guide sheath

doi:10.3877/cma.j.issn.1674-6902.2017.02.002

Abstract

Abstract:

Objective

Virtual bronchoscopic navigation (VBN) can guide a bronchoscope under direct observation using virtual bronchoscopic images, VBN may be useful in diagnosing pulmonary lesions when combined with Endobronchial ultrasonography with a guide sheath(EBUS-GS). To evaluate the value of VBN-assisted EBUS-GS for diagnosing peripheral lung cancer.

Methods

All 385 patients with peripheral lung cancer diagnosed with HRCT(8 mm≤diameter≤30 mm)were randomly assigned to VBN-assisted EBUS-GS group, non-VBN-assisted EBUS-GS group or conventional bronchoscopy group.

Results

Subjects for analysis include 294 patients diagnosed as primary lung cancer finally. There was no significant difference in the diagnostic yield between the VBN-assisted EBUS-GS group and the non-VBN-assisted EBUS-GS group(82.5%/81.3%, P>0.05), but compared with conventional bronchoscopy group, the VBN-assisted EBUS-GS group and the non-VBN-assisted EBUS-GS group had a significantly higher diagnostic yield(82.5%/81.3%/43.3%, P<0.05). The subgroup analysis showed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter and a probe position that was within the lesion.

Conclusions

VBN-assisted EBUS-GS or EBUS-GS improves the diagnostic yield for peripheral lung cancer. The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in peripheral lung cancer were as follows: CT bronchus sign positivity, a lesion of >20 mm in diameter and a probe position that was within the lesion.

Key words: Endobronchial ultrasonography with a guide sheath, Virtual bronchoscopic navigation, Bronchus lung cancer, Transbronchial biopsy

Lei Pan, Liyan Bo, Wangping Li, Wei Liu, Deguang Mu, Enqing Fu, Yonghong Xie, Yandong Nan, Faguang Jin. Clinical study on diagnosis of peripheral lung cancer with virtual bronchoscopic navigation combined with endobronchial ultrasonography with a guide sheath[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(02): 124-129.

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References 27

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临床资料		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)
年龄(岁)		43～88	45～87	56～85
男性		58 (59.8)	69(64.5)	56(62.2)
病变位置	上叶	50	58	45
?	中叶或舌叶	10	11	9
?	下叶	37	38	36
病变大小，mm		8～29	8～30	8～30
≤20mm，n(%)		45 (46.4)	47 (43.9)	40(44.4)
>20～30mm, n(%)		52 (53.6)	60 (56.1)	50(55.6)
CT支气管征象		?	?	?
?	阳性	78	85	72
?	阴性	19	22	18
超声探头位置		?	?	?
?	病变内部	46	51	41
?	紧邻病变	33	37	32
?	病变之外	18	19	17
最后诊断		?	?	?
?	腺癌	66 (68.0)	74(69.2)	61(67.8)
?	鳞癌	13(13.4)	15(14.0)	11(12.2)
?	小细胞肺癌	7(7.2)	9(8.4)	7(7.8)
?	非小细胞肺癌	8(8.2)	9(8.4)	7(7.8)
?	大细胞肺癌	2(2.1)	0(0)	3(3.3)
?	腺鳞癌	1(1.0)	0(0)	1(1.1)

临床资料		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)
年龄(岁)		43～88	45～87	56～85
男性		58 (59.8)	69(64.5)	56(62.2)
病变位置	上叶	50	58	45
?	中叶或舌叶	10	11	9
?	下叶	37	38	36
病变大小，mm		8～29	8～30	8～30
≤20mm，n(%)		45 (46.4)	47 (43.9)	40(44.4)
>20～30mm, n(%)		52 (53.6)	60 (56.1)	50(55.6)
CT支气管征象		?	?	?
?	阳性	78	85	72
?	阴性	19	22	18
超声探头位置		?	?	?
?	病变内部	46	51	41
?	紧邻病变	33	37	32
?	病变之外	18	19	17
最后诊断		?	?	?
?	腺癌	66 (68.0)	74(69.2)	61(67.8)
?	鳞癌	13(13.4)	15(14.0)	11(12.2)
?	小细胞肺癌	7(7.2)	9(8.4)	7(7.8)
?	非小细胞肺癌	8(8.2)	9(8.4)	7(7.8)
?	大细胞肺癌	2(2.1)	0(0)	3(3.3)
?	腺鳞癌	1(1.0)	0(0)	1(1.1)

临床资料及变量		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)	P值
总诊断率		80/97(82.5)	87/107(81.3)	39/90(43.3)	^eP＝0.487；^fP<0.001
男性		48/58(82.8)	56/69(81.2)	24/56(42.9)	^aP＝0.568
女性		32/39(82.1)	31/38(81.6)	15/34(44.1)	^bP＝0.587；^cP＝0.492
病变位置	上叶	41/50(82.0)	47/58(81.0)	19/45(42.2)	^aP＝0.967
?	中叶或舌叶	8/10(80.0)	9/11(81.8)	4/9(44.4)	^bP＝0.993
?	下叶	30/37(81.1)	31/38(81.6)	16/36(44.4)	^cP＝0.978
病变大小		?	?	?	^aP＝0.001
?	≤20 mm	31/45(68.9)	31/47(66.0)	11/40(27.5)	^bP<0.001
?	>20～30 mm	49/52(94.2)	56/60(93.3)	28/50(56.0)	^cP＝0.006
CT支气管征象	阳性	70/78(89.7)	76/85(89.4)	35/72(48.6)	^aP＝0.001
?	阴性	10/19(52.6)	11/22(50.0)	4/18(22.2)	^bP<0.001；^cP＝0.037
超声探头位置	病变内部	45/46(97.8)	49/51(96.1)	无	^aP<0.001
?	紧邻病变	31/33(93.9)	33/37(89.2)	?	^bP<0.001
?	病变之外	4/18(22.2)	5/19(26.3)	?	?

临床资料及变量		VBN＋EBUS-GS(n＝97)	EBUS-GS(n＝107)	常规支气管镜(n＝90)	P值
总诊断率		80/97(82.5)	87/107(81.3)	39/90(43.3)	^eP＝0.487；^fP<0.001
男性		48/58(82.8)	56/69(81.2)	24/56(42.9)	^aP＝0.568
女性		32/39(82.1)	31/38(81.6)	15/34(44.1)	^bP＝0.587；^cP＝0.492
病变位置	上叶	41/50(82.0)	47/58(81.0)	19/45(42.2)	^aP＝0.967
?	中叶或舌叶	8/10(80.0)	9/11(81.8)	4/9(44.4)	^bP＝0.993
?	下叶	30/37(81.1)	31/38(81.6)	16/36(44.4)	^cP＝0.978
病变大小		?	?	?	^aP＝0.001
?	≤20 mm	31/45(68.9)	31/47(66.0)	11/40(27.5)	^bP<0.001
?	>20～30 mm	49/52(94.2)	56/60(93.3)	28/50(56.0)	^cP＝0.006
CT支气管征象	阳性	70/78(89.7)	76/85(89.4)	35/72(48.6)	^aP＝0.001
?	阴性	10/19(52.6)	11/22(50.0)	4/18(22.2)	^bP<0.001；^cP＝0.037
超声探头位置	病变内部	45/46(97.8)	49/51(96.1)	无	^aP<0.001
?	紧邻病变	31/33(93.9)	33/37(89.2)	?	^bP<0.001
?	病变之外	4/18(22.2)	5/19(26.3)	?	?

[1]	Jing Zhao, Ye Fan, Yating You, Hui Chen, Jing Wang, Jing Zhang. Diagnostic value of ultrasound image features combined with virtual bronchoscopic navigation and radial endobronchial ultrasound in peripheral lung cancer [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(04): 524-528.
[2]	Jian Sun, Xiaoyan Li, Zhaoqiang Ren, Xiaoli Feng, Jie He. Diagnostic value of virtual bronchoscopic navigation guided transbronchial lung biopsy for peripheral pulmonary lesions [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(01): 49-52.

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