Application of radial probe endobronchial ultrasound-guided bronchoscope for transbronchial lung biopsy in diagnosis of peripheral pulmonary lesions

doi:10.3877/cma.j.issn.1674-6902.2019.05.009

Abstract

Abstract:

Objective

To explore the application and value of radial probe endobronchial ultrasound-guided bronchoscope for transbronchial lung biopsy (R-EBUS-TBLB) in the diagnosis of peripheral pulmonary lesions (PPLs) and to evaluate the diagnostic success rate, influencing factors and safety.

Methods

The clinical data of 86 patients with PPLs who received R-EBUS-TBLB in our hospital from August 2017 to January 2019 were retrospectively summarized. The ability of R-EBUS to locate the lesions was observed, the success rate of diagnosis and its influencing factors were analyzed, and the complications were observed for safety assessment.

Results

The detection rate of R-EBUS for lesions was 89.53% (77/86) and the total diagnosis rate of R-EBUS-TBLB in the patients with PPLs was 59.30% (51/86). The diagnosis rate of the lesions with the diameter ≥2 cm, being located in the middle or lower lobe, close to the hilum, with uneven echo inside the ultrasound, and with discontinuous edges was higher than that of the lesions with the diameter <2 cm, being located in the upper lobe, far from the hilum, with uniform echo inside the ultrasound, and with continuous edges (P<0.05). The diagnosis rate of the lesions wrapping the ultrasonic probe was 78.26% (36/46) and the diagnosis rate of the lesions whose edges were adjacent to the ultrasonic probe was 41.94 % (13/31). The difference between the two groups was statistically significant (P<0.05). The diagnostic sensitivity of R-EBUS-TBLB to PPLs was 59.30%, the specificity was 100%, and the positive predictive value and the negative predictive value were 100% and 42.22%, respectively. The safety of R-EBUS-TBLB was relatively high. Only 7 out of the 86 subjects needed local hemostasis under the microscope, and the rest with small amounts of bleeding needed no special treatment. No pneumothorax or other complications were observed.

Conclusion

R-EBUS-TBLB is safe and effective, which has an important diagnostic significance and a high application value for PPLs. The size and location of the lesions, the relationship between the ultrasonic probe, and the location of the lesions are the main factors affecting the diagnostic efficacy of R-EBUS-TBLB.

Key words: Endobronchial ultrasonography, Peripheral pulmonary lesions, Transbronchial lung biopsy, Measurement techniques

Zongjuan Ming, Dexin Zhang, Wei Li, Hongyang Shi, Ping He, Xia Yang, Ping Fang, Mei Xie, Jie Lyu, Meng Li, Shuanying Yang. Application of radial probe endobronchial ultrasound-guided bronchoscope for transbronchial lung biopsy in diagnosis of peripheral pulmonary lesions[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(05): 579-584.

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Figures/Tables 4

References 31

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临床资料		例数	确诊例数(%)	χ²值	P值
超声探头位置
	在病灶内	46	36(78.26)	15.852	<0.001
	邻近病灶	31	13(41.94)
	未探及病灶	9	2(22.22)
超声图像边缘
	连续	41	20(48.78)	7.047	0.008
	不连续	36	29(80.56)
超声内部回声
	均匀	31	12(38.71)	12.188	<0.001
	不均匀	46	37(80.43)
病灶直径大小
	直径≥3 cm	19	16(84.21)	19.896	<0.001
	2 cm≤直径<3 cm	44	37(61.36)
	直径<2 cm	23	8(34.78)
病灶位置
	双上叶	21	7(33.33)	8.202	0.017
	右中叶	35	25(71.42)
	双下叶	30	19(63.33)
病灶与肺门距离
	距离肺门≥5 cm	41	18(43.90)	6.528	0.011
	距离肺门<5 cm	45	33(73.33)
麻醉方式
	局麻	23	12(52.17)	0.319	0.572
	全麻	63	39(61.90)

临床资料		例数	确诊例数(%)	χ²值	P值
超声探头位置
	在病灶内	46	36(78.26)	15.852	<0.001
	邻近病灶	31	13(41.94)
	未探及病灶	9	2(22.22)
超声图像边缘
	连续	41	20(48.78)	7.047	0.008
	不连续	36	29(80.56)
超声内部回声
	均匀	31	12(38.71)	12.188	<0.001
	不均匀	46	37(80.43)
病灶直径大小
	直径≥3 cm	19	16(84.21)	19.896	<0.001
	2 cm≤直径<3 cm	44	37(61.36)
	直径<2 cm	23	8(34.78)
病灶位置
	双上叶	21	7(33.33)	8.202	0.017
	右中叶	35	25(71.42)
	双下叶	30	19(63.33)
病灶与肺门距离
	距离肺门≥5 cm	41	18(43.90)	6.528	0.011
	距离肺门<5 cm	45	33(73.33)
麻醉方式
	局麻	23	12(52.17)	0.319	0.572
	全麻	63	39(61.90)

[1]	Shiyuan Liu, Hao Lin, Qian Li, Zhe Qiao, Shaomi Li. Diagnostic value of ultrasound-guided percutaneous lung biopsy in peripheral lung lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(06): 573-577.
[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.
[3]	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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