电磁导航支气管镜引导冷冻肺活检对肺外周结节的诊断价值
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摘要
目的评价电磁导航引导冷冻肺活检对外周型肺孤立型小结节(SPN)的诊断价值。方法回顾性分析2016年1月1日-2018年7月8日于该院用不同方法行经支气管肺组织活检的76例外周型SPN(直径≤3.0 cm)患者的临床资料,根据活检方法的不同分为电磁导航引导冷冻肺活检(ENBCB)组和电磁导航引导活检钳肺活检(ENBLB)组,比较两种活检方法的标本大小、诊断率、操作时间及并发症,最后诊断结果通过外科手术切除病灶行病理检查或者随访2年至临床治愈确诊。结果 ENBCB组和ENBLB组的病灶平均直径分别为(21.0±8.0)和(22.0±8.0)mm。两组病灶大小比较,差异无统计学意义(t=0.68,P=0.590)。ENBCB组及ENBLB组活检标本大小分别为(10.5±4.2)和(2.9±1.3)mm~2,差异有统计学意义(t=-14.56,P <0.05);ENBCB组和ENBLB组的诊断率分别为89.2%(33/37)和69.2%(27/39),ENBCB组诊断率高于ENBLB组(χ~2=4.55,P=0.033)。亚组分析:病灶直径为2.0～3.0 cm时两组诊断率差异无统计学意义(χ~2=0.00,P=1.000);病灶直径<2.0 cm时,ENBCB组诊断率高于ENBLB组(χ~2=4.88,P=0.027)。ENBCB组与ENBLB组的操作时间分别为(64.7±14.2)和(36.4±12.8)min,两组差异有统计学意义(t=-18.78,P=0.002);并发症方面,两组均未发生严重大出血和气胸,轻到中度出血的病例ENBCB组为40.5%(15/37),ENBLB组为17.9%(7/39),差异有统计学意义(χ~2=4.71,P=0.030)。结论与ENBLB相比,ENBCB操作时间相对较长,但在获得标本大小及提高外周型SPN的诊断率方面具有优势,安全性良好。
Objective To investigate the diagnostic value of electromagnetic navigation bronchoscopy guidance transbronchial lung cryobiopsy for solitary pulmonary nodules(SPN). Methods 76 patients with peripheral pulmonary lesions(diameter < 3.0 cm) who experienced diverse manners of transbronchial lung biopsy from January 1, 2016 to July 8, 2018 were analyzed retrospectively. The patients were divided into electromagnetic navigation bronchoscopy guidance cryobiopsy(ENBCB) group and electromagnetic navigation bronchoscopy guidance lung biopsy(ENBLB) group. We compared the size of biopsy specimens, diagnostic yield, operation time and complications between these two groups. The final diagnosis was identified by pathologic examination of surgically resected lesions or by 2 year follow-up until clinical cure stage. Results The lesion size of the ENBCB group, the ENBLB group were(21.0 ± 8.0) mm,(22.0 ± 8.0) mm. Furthermore, no significant difference was found in diagnostic yields by lesion size(t = 0.68, P = 0.590). The size of biopsy specimens in ENBCB group(10.5 ± 4.2) mm2 is bigger than that in ENBLB group(2.9 ± 1.3) mm2(t =-14.56, P < 0.05). Pathological results indicated that the diagnostic yield of ENBCB group was 89.2%(33/37) and that of ENBLB group was 69.2%(27/39), the difference between the addressed groups being statistical significant(χ~2 = 4.55, P = 0.033). Subgroup analysis demonstrated that, as the lesion diameter was 2.0 ～ 3.0 cm, there was no statistical difference of diagnostic yield between the two groups(χ~2 = 0.00, P = 1.000), while as the lesion diameter was < 2.0 cm, the diagnostic yield in ENBCB group was increased compared with ENBLB group(χ~2 = 4.88, P = 0.027). The procedure time remained significantly longer in the ENBCB group(64.7 ± 14.2) min than ENBLB group(36.4 ± 12.8) min(t =-18.78, P = 0.002). There was no pneumothorax or severe bleeding after operation. The rate of mild to moderate bleeding in ENBCB group and ENBLB group was40.5%(15/37) and 17.9%(7/39)(χ~2 = 4.71, P = 0.030) respectively. Conclusions Compared with ENBLB biopsy group, the procedure time of ENBCB group remained significantly longer. However, ENBCB for small peripheral pulmonary lesions is secure, and has higher diagnostic rate.
Objective To investigate the diagnostic value of electromagnetic navigation bronchoscopy guidance transbronchial lung cryobiopsy for solitary pulmonary nodules(SPN). Methods 76 patients with peripheral pulmonary lesions(diameter < 3.0 cm) who experienced diverse manners of transbronchial lung biopsy from January 1, 2016 to July 8, 2018 were analyzed retrospectively. The patients were divided into electromagnetic navigation bronchoscopy guidance cryobiopsy(ENBCB) group and electromagnetic navigation bronchoscopy guidance lung biopsy(ENBLB) group. We compared the size of biopsy specimens, diagnostic yield, operation time and complications between these two groups. The final diagnosis was identified by pathologic examination of surgically resected lesions or by 2 year follow-up until clinical cure stage. Results The lesion size of the ENBCB group, the ENBLB group were(21.0 ± 8.0) mm,(22.0 ± 8.0) mm. Furthermore, no significant difference was found in diagnostic yields by lesion size(t = 0.68, P = 0.590). The size of biopsy specimens in ENBCB group(10.5 ± 4.2) mm2 is bigger than that in ENBLB group(2.9 ± 1.3) mm2(t =-14.56, P < 0.05). Pathological results indicated that the diagnostic yield of ENBCB group was 89.2%(33/37) and that of ENBLB group was 69.2%(27/39), the difference between the addressed groups being statistical significant(χ~2 = 4.55, P = 0.033). Subgroup analysis demonstrated that, as the lesion diameter was 2.0 ～ 3.0 cm, there was no statistical difference of diagnostic yield between the two groups(χ~2 = 0.00, P = 1.000), while as the lesion diameter was < 2.0 cm, the diagnostic yield in ENBCB group was increased compared with ENBLB group(χ~2 = 4.88, P = 0.027). The procedure time remained significantly longer in the ENBCB group(64.7 ± 14.2) min than ENBLB group(36.4 ± 12.8) min(t =-18.78, P = 0.002). There was no pneumothorax or severe bleeding after operation. The rate of mild to moderate bleeding in ENBCB group and ENBLB group was40.5%(15/37) and 17.9%(7/39)(χ~2 = 4.71, P = 0.030) respectively. Conclusions Compared with ENBLB biopsy group, the procedure time of ENBCB group remained significantly longer. However, ENBCB for small peripheral pulmonary lesions is secure, and has higher diagnostic rate.
引文
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[13]BIGRAS G,MAIRS S,SWANSON P E,et al.Small biopsies misclassify up to 35%of PD-L1 assessments in advanced lung non-small cell lung carcinomas[J].Appl Immunohistochem Mol Morphol,2018,26(10):701-708.
[14]FRANKE K J,LINZENBOLD W,NUESSLE D,et al.A new tool for transbronchial cryobiopsies in the lung:an experimental feasibility ex vivo study[J].Respiration,2016,91(3):228-234.
[15]HETZEL J,MALDONADO F,RAVAGLIA C,et al.Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases:expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure[J].Respiration,2018,95(3):188-200.
[16]李时悦,陈小波.呼吸系统冷冻活检的几个关键问题[J].中华结核和呼吸杂志,2018,41(6):401-403.[16]LI S Y,CHEN X B.Several key problems with respiratory cryobiopsies[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2018,41(6):401-403.Chinese
[17]潘蕾,段锐,薄丽艳,等.虚拟支气管镜导航联合超细支气管镜诊断肺外周病变的随机临床试验研究[J].中华肺部疾病杂志:电子版,2015,8(5):20-24.[17]PAN L,DUAN R,BO L Y,et al.A randomized clinical trial on diagnosis of peripheral pulmonary lesion with virtual bronchoscopic navigation combined with ultrathin brochoscopy[J].Chinese Journal of Lung Diseases:Electronic Edition,2015,8(5):20-24.Chinese
[2]TESSEMA M,ROSSI M R,PICCHI M A,et al.Common cancerdriver mutations and their association with abnormally methylated genes in lung adenocarcinoma from never-smokers[J].Lung Cancer,2018,123:99-106.
[3]TAIRA N,KAWASAKI H,TAKAHARA S,et al.The presence of coexisting lung cancer and non-tuberculous mycobacterium in a solitary mass[J].Am J Case Rep,2018,19:748-751.
[4]TOWE C W,NEAD M A,RICKMAN O B,et al.Safety of electromagnetic navigation bronchoscopy in patients with COPD:results from the NAVIGATE study[J].J Bronchology Interv Pulmonol,2019,26(1):33-40.
[5]张辉军,张龙富,叶茂松,等.国产电磁导航支气管镜检查定位系统引导经支气管镜肺活检术对肺外周病灶的诊断价值[J].复旦学报(医学版),2017,44(3):348-352.[5]ZHANG H J,ZHANG L F,YE M S,et al.Domestic electromagnetic navigation bronchoscopy guided transbronchial lung biopsy for the diagnosis of peripheral pulmonary lesions[J].Fudan University Journal of Medical Sciences,2017,44(3):348-352.Chinese
[6]CHENG S L,CHU C M.Electromagnetic navigation bronchoscopy under intravenous sedation-tips and tricks[J].J Thorac Dis,2018,10(Suppl 6):S769-S774.
[7]KHANDHAR S J,BOWLING M R,FLANDES J,et al.Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects:first results of the prospective,multicenter NAVIGATE study[J].BMC Pulm Med,2017,17(1):59.
[8]SRIKANTA J T,SWARNA S,SHYLENDRA D S,et al.Transbronchial lung cryobiopsy for diagnosis of pediatric interstitial lung disease[J].Indian Pediatr,2018,55(6):519-520.
[9]VIGLIETTA L,INCHINGOLO R,PAVANO C,et al.Ultrasonography for the diagnosis of pneumothorax after transbronchial lung cryobiopsy in diffuse parenchymal lung diseases[J].Respiration,2017,94(2):232-236.
[10]陈小波,罗群,陈愉,等.冷冻肺活检对间质性肺疾病诊断有效性及安全性的前瞻性研究[J].中华结核和呼吸杂志,2018,41(6):467-471.[10]CHEN X B,LUO Q,CHEN Y,et al.The efficacy and safety of transbronchial lung cryobiopsy in interstitial lung disease:a prospective study[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2018,41(6):467-471.Chinese
[11]陈愉,李时悦,陈汉章,等.电磁导航支气管镜实时引导肺活检对肺外周微小病变的诊断价值[J].中华结核和呼吸杂志,2014,37(8):579-582.[11]CHEN Y,LI S Y,CHEN H Z,et al.Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for the diagnosis of small peripheral pulmonary lesions[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2014,37(8):579-582.Chinese
[12]KARAM M B,DOROUDINIA A,BEHZADI B,et al.Correlation of quantified metabolic activity in nonsmall cell lung cancer with tumor size and tumor pathological characteristics[J].Medicine(Baltimore),2018,97(32):e11628.
[13]BIGRAS G,MAIRS S,SWANSON P E,et al.Small biopsies misclassify up to 35%of PD-L1 assessments in advanced lung non-small cell lung carcinomas[J].Appl Immunohistochem Mol Morphol,2018,26(10):701-708.
[14]FRANKE K J,LINZENBOLD W,NUESSLE D,et al.A new tool for transbronchial cryobiopsies in the lung:an experimental feasibility ex vivo study[J].Respiration,2016,91(3):228-234.
[15]HETZEL J,MALDONADO F,RAVAGLIA C,et al.Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases:expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure[J].Respiration,2018,95(3):188-200.
[16]李时悦,陈小波.呼吸系统冷冻活检的几个关键问题[J].中华结核和呼吸杂志,2018,41(6):401-403.[16]LI S Y,CHEN X B.Several key problems with respiratory cryobiopsies[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2018,41(6):401-403.Chinese
[17]潘蕾,段锐,薄丽艳,等.虚拟支气管镜导航联合超细支气管镜诊断肺外周病变的随机临床试验研究[J].中华肺部疾病杂志:电子版,2015,8(5):20-24.[17]PAN L,DUAN R,BO L Y,et al.A randomized clinical trial on diagnosis of peripheral pulmonary lesion with virtual bronchoscopic navigation combined with ultrathin brochoscopy[J].Chinese Journal of Lung Diseases:Electronic Edition,2015,8(5):20-24.Chinese